Introduced March 25, 2026
On March 25, 2026, bipartisan legislation titled the Outpatient Surgery Access Act of 2026 was introduced in Congress. The legislation is supported by the Ambulatory Surgery Center Association (ASCA) and seeks to improve long-term Medicare reimbursement stability for ASCs.
Key provisions include:
The current hospital market basket methodology used for ASC annual updates expires at the end of 2026. Without this bill, ASC updates would revert to CPI-U, which typically yields lower annual increases. The bill was introduced by Representatives Beth Van Duyne (R-TX) and John Larson (D-CT) and has formal endorsement from ASCA.
This bill is a direct CASA advocacy priority. Member engagement with California congressional delegations on this legislation is encouraged before the 2026 market basket policy expires.
ASC News - ASC Payment Fight Returns
Effective April 6, 2026
CMS released the April 2026 quarterly update to the ASC Payment System through Change Request (CR) 14445. ASCs were advised to update chargemasters, billing systems, and coding files to ensure compliance.
The update included:
ASCs should verify that chargemasters, billing systems, and coding files have been updated to reflect the April 6, 2026 changes from CR 14445.
CMS Transmittal R13704CP - April 2026 ASC Quarterly Update (CR 14445)
Effective December 15, 2025
CMS continues implementation of its prior authorization demonstration project affecting certain ASC procedures in ten states, including California. This remains an important operational and revenue cycle issue for California ASCs due to increased administrative burden and potential reimbursement delays.
The demonstration:
California is one of ten states included in this demonstration. ASCs should ensure prior authorization workflows are in place for affected procedure codes to avoid claim denials and payment delays.
CMS Prior Authorization Demonstration for Certain ASC Services
Effective January 1, 2026
The CY 2026 OPPS/ASC Final Rule took effect January 1, 2026. Its provisions continue to shape ASC operations and revenue through the remainder of the year.
Payment Rate
The 2026 ASC payment update is +2.6% (hospital market basket of 3.3% minus a 0.7% productivity adjustment). The new ASC conversion factor is $56.322, up from $54.895 in 2025, and applies to ASCs meeting quality reporting requirements
Cardiac Ablation - Major Cardiology Win
** California: State Legislative Statute Limitations**
**Cardiac catheter ablation was added to the ASC Covered Procedures List for the first time in Medicare history. CPT codes 93650, 93653, 93654, and 93656 are covered effective January 1, 2026. ASCs can now bill Medicare for cardiac ablation procedures, opening a major new revenue stream in cardiology.
ASC Covered Procedures List Expansion
276 procedures were added based on the removal of five restrictive exclusion criteria - the largest single-year expansion in recent history. In addition, 285 procedures (mostly musculoskeletal) were removed from the Inpatient Only (IPO) list, with the full elimination of the IPO list mandated by January 1, 2029. This represents a significant opportunity for ASCs to add procedures currently performed only in hospital inpatient settings.
Four measures were removed from the ASCQR program:
CMS CY 2026 OPPS/ASC Final Rule Fact Sheet
Federal Register - CY 2026 OPPS/ASC Final Rule
MedTech Dive - CMS Covers Cardiac Ablation in ASCs
American College of Cardiology - 2026 OPPS Final Rule Highlights
VMG Health - CY 2026 OPPS/ASC Payment System Final Rule
The One Big Beautiful Bill Act (signed July 4, 2025) enacted nearly $1 trillion in Medicaid cuts over 10 years. Key provisions are rolling into effect in 2026 and beyond with direct implications for ASC patient volume.
Key provisions:
Medicaid coverage losses will reduce patient access to elective and non-emergency procedures. ASCs should assess their Medi-Cal patient mix and monitor California's state budget response through summer 2026.
AMA - Changes to Medicaid in the One Big Beautiful Bill Act
Fierce Healthcare - 2026 Outlook: Domino Effect of Medicaid Cuts
Healthcare Dive - House Passes Reconciliation Bill with Massive Medicaid Cuts
Effective May 9, 2024 - Equipment Deadline July 8, 2026
In May 2024, the U.S. Department of Health and Human Services (HHS) updated Section 504 of the Rehabilitation Act, establishing enforceable federal standards requiring healthcare providers receiving federal financial assistance — including ambulatory surgery centers that bill Medicare or Medicaid — to ensure equitable access for patients with disabilities.
Key compliance deadlines:
CASA has reached out to a healthcare attorney (Fisher Phillips) to provide an educational resource for our members as part of the Administrator Mastery Series or as a standalone session. We have also approached ASCA for additional guidance on the direction they are providing to members.
Non-compliance carries meaningful risk. Patients may file complaints with the HHS Office for Civil Rights or pursue direct litigation in federal court under Section 504’s private right of action. ASCs should assess compliance readiness now, given that the July 8, 2026, equipment deadline is weeks away.
At the CASA Conference, hear directly from CASA Advocates Alison Ramey and Ryan Pierini, alongside ASCA Representatives Bill Prentice and Kara Newbury. This Thursday morning session will provide a comprehensive overview of current and emerging legislation affecting Ambulatory Surgery Centers (ASCs) at both the state and national levels. Attendees will gain insights into regulatory challenges, advocacy efforts, and policy developments that shape the ASC environment in California and across the country.
From regulatory challenges to emerging policy shifts, this session gives you the insight you need to protect your ASC and plan ahead.
The CASA Conference is where it happens. Be in the room!