ASCA Advocates for Medicare Reimbursement for More Cardiovascular Codes

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ASCA Advocates for Medicare Reimbursement for More Cardiovascular Codes

New developments increase momentum for future addition

Cardiology has been a growing sector for surgery centers for the past several years, but the Centers for Medicare & Medicaid Services (CMS) has been slow to allow for many of these procedures to be performed on the Medicare population in ASCs. ASCA is working closely with specialty organizations to encourage CMS to provide Medicare beneficiaries access to its facilities for cardiovascular procedures that are not on the ASC Covered Procedures list (ASC-CPL), especially cardiac ablation codes.

History of Cardiology Codes on the ASC-CPL

In its 2019 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System final rule, CMS revised the definition of “surgery” in the ASC payment system to account for certain “surgery-like” procedures that are assigned codes outside the Current Procedural Terminology (CPT) surgical range. This definitional change allowed for the addition of 12 cardiac catheterization procedures that were in the proposed rule, as well as five additional procedures performed during cardiac catheterization procedures, to the list of ASC covered surgical procedures.

In its 2020 OPPS and ASC Payment System final rule, CMS added more cardiovascular procedures to the ASC-CPL, including percutaneous coronary interventions (PCI), which were much requested by ASCA members.

Recent Efforts

Cardiac ablation codes have been a focus for ASCA over the past couple of years, and ASCA has partnered with cardiovascular groups to present its case to CMS. In addition to meetings with CMS staff, ASCA has requested these codes in recent comment letters and through the new Pre-Proposed Rule Recommendation Request process that was rolled out just this year. It was disappointing that the cardiology codes, especially cardiac ablation codes, were not even mentioned in the 2025 proposed rule.

Since the codes were not proposed for consideration, it is extremely unlikely that they will be finalized for inclusion on the ASC-CPL in 2025. However, new research and support from specialty societies is an encouraging sign that we could see movement in 2026.

The Heart Rhythm Society (HRS) recently presented data to CMS that supports the continued expansion of the ASC-CPL with cardiovascular codes, including cardiac ablation services. Of note, electrophysiologists recently conducted a large, multicenter safety and feasibility study of more than 4,000 cardiac electrophysiology procedures performed across six ASCs during the COVID-19 pandemic under the CMS Hospitals Without Walls program. Findings from the study demonstrate that catheter ablations performed in ASCs and hospital outpatient departments (HOPD) both had very low rates of acute complications, even lower than other comparable cardiac procedures already covered on the ASC-CPL (i.e., pacemakers/ICD implants and elective PCI procedures). Catheter ablation procedures performed in the ASC setting demonstrated lower rates of urgent hospital admissions than at HOPDs and very low rates of 30-day admissions.

On a recent episode of ASCA’s Advancing Surgical Care Podcast, “Adding Cardiovascular Procedures to the ASC Covered Procedures List,” one of the contributors of the safety and feasibility study examined why these procedures should be accessible to ASC patients. Florida-based clinical cardiac electrophysiologist David Kenigsberg, MD, discussed the cardiology codes that ASCA, the American College of Cardiology (ACC), HRS and others are urging CMS to add to its ASC-CPL. During the conversation, Kenigsberg cited widespread physician support for these recommendations, high-quality patient outcomes and satisfaction levels, and several large studies that reveal low complication rates.

The ACC also is engaging on this issue. Recognizing the growth of cardiovascular services in surgery centers, in February 2024, the ACC rolled out a CV ASC Registry Suite “to allow facilities to measure and compare their patient care and outcomes to similar procedures performed in the hospital outpatient setting.” This data will further support ASCA’s efforts in the future.

Write Kara Newbury at knewbury@ascassociation.org with questions.