Comment now on Medicare’s 2027 proposed rule

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Comment now on Medicare’s 2027 proposed rule

Use ASCA resources to write your letter

By Kara Newbury

Comments on the Centers for Medicare & Medicaid Services’ 2027 proposed payment rule for ASCs and hospital outpatient departments are due on Aug. 31, 2026. CMS is accepting comments online and ASCA encourages all members to submit facility-specific feedback. ASCA will once again submit comments raising industry-wide concerns, but it is important that CMS hears from individual centers as well.

As a special member resource, ASCA has created customizable comment letter templates. Members can add their facility letterhead and tailor the letters to address key issues, including:

  • Removal of the secondary rescaling applied to ASCs, a policy that contributes to the growing disparity in reimbursement rates between ASCs and HOPDs.
  • Additional codes to be added to the ASC Covered Procedures List.
  • Addition of unlisted codes to be reimbursed in the ASC setting.

Members also can access ASCA’s proposed rule rate calculator (select the 2027 tab under “Medicare Payment Resources by Year”) to view proposed national and local ASC payment rates for 2027, including rates for the 618 codes proposed for addition to the ASC-CPL.

Additional member resources are available on ASCA’s Medicare Payment Resources webpage, including the text of the rule, an analysis that identifies and summarizes major provisions of the rule, and a payment resources document that breaks out ASC-CPL codes into groups including separately payable, office-based and device-intensive. Members must log in to access all resources.

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CMS released its proposed rule on July 2. Consistent with ASCA’s recommendation, the agency proposed to continue to align the ASC update factor with the one used to update HOPD payments, extending the interim period an additional calendar year through 2027.

For the second year in a row, CMS also proposed a significant expansion of the ASC-CPL by adding 618 codes, including the four hernia codes ASCA requested:

  • 49596 (Rpr aa hrn 1st > 10 ncr/strn)
  • 49616 (Rpr aa hrn rcr 3-10 ncr/strn)
  • 49617 (Rpr aa hrn rcr > 10 rdc)
  • 49618 (Rpr aa hrn rcr > 10 ncr/strn)

CMS proposed the removal of 637 codes from the inpatient-only list for 2027 as part of its three-year phaseout of the IPO list. The 19 codes that were removed from the IPO list but not added to the ASC-CPL are primarily unlisted codes.

Current Medicare regulations prohibit ASCs from seeking reimbursement for unlisted codes, even though CMS permits their use in HOPDs and physician offices and commercial payers routinely reimburse ASCs for unlisted-code procedures. ASCA will continue to advocate that CMS revise the Code of Regulations to eliminate this restriction.

Write Kara Newbury at knewbury@ascassociation.org if you need help customizing your comment letter or have any questions. In addition, ASCA would like to track the number of members who comment, so please email Newbury if you submit comments.