CMS proposal to end inpatient only list draws strong industry response

Editor's Note

The plan to eliminate the Medicare Inpatient-Only (IPO) List and expand the Ambulatory Surgery Center Covered Procedures List (ASC-CPL) from the Centers for Medicare & Medicaid Services (CMS) has generated widespread reaction, with more than 3,900 comments submitted during the official feedback period, Ambulatory Surgery Center News September 16 reports.

CMS’s 2026 proposed payment rule for ASCs, unveiled July 15, also includes a modest payment adjustment and updates to the ASC Quality Reporting program. Supporters praised the proposal for giving clinicians more latitude to determine the most appropriate care setting. Industry leaders, including the Ambulatory Surgery Center Association (ASCA), argued that physician judgment should guide site-of-service decisions and reiterated long-standing calls for payment alignment between ASCs and hospital outpatient departments.

Two dozen state ASC associations submitted a joint letter thanking CMS for continuing to use the hospital market basket as the update mechanism for ASC payments. However, they urged the agency to eliminate the ASC weight scalar or apply a unified budget neutrality calculation across outpatient payment systems. The groups also requested CMS add specific cardiology codes, including electrophysiology studies and cardioversions, to the ASC-CPL in 2026.

Commenters broadly supported expanding outpatient options but raised concerns about patient costs. Unlike hospital outpatient services, ASC services do not cap patient coinsurance liability, which could leave Medicare beneficiaries with out-of-pocket bills ranging from $1,684 to $8,373 for certain procedures. ASCA has pushed for legislative fixes, including the Medicare Beneficiary Co-Pay Fairness Act.

Proposed changes to ASCQR, which would remove measures tied to COVID-19 vaccination status and social determinants of health, were generally welcomed. Many respondents agreed such data collection is not relevant in the ASC environment, which rarely involves repeat encounters or social work interventions.

Not all feedback was favorable. Some commenters warned that moving hundreds of procedures from inpatient-only status to ASCs could jeopardize patient safety. Others criticized CMS’s limited interpretation of the NOPAIN Act, which was designed to increase Medicare patient access to non-opioid pain management. Commenters argued current policy undermines the law’s intent and restricts access to FDA-approved alternatives.

CMS is expected to release its final ASC payment rule for 2026 in early November after reviewing the public comments.