In its 2023 final payment rule for ASCs and hospital outpatient departments (HOPD), the Centers for Medicare & Medicaid Services (CMS) showed a willingness to advance policies that will drive volume to the ASC setting and save Medicare and its beneficiaries money. Still, ASCs face many hurdles under the final rule, and significant advocacy work will be needed to advance the interests of the ASC community in 2024 and beyond.