ASCA Submits Codes for Addition to Medicare Payable List

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ASCA Submits Codes for Addition to Medicare Payable List

Cardiology and spine procedures requested for 2026 rulemaking

BY KARA NEWBURY | MARCH 14, 2025

ASCA submitted codes in response to the Centers for Medicare & Medicaid Services’ (CMS) ASC Covered Procedures List (ASC-CPL) Pre-Proposed Rule Recommendation Request on February 28. Based on feedback from ASCA members, including its cardiovascular working group, ASCA submitted the following codes to be added to the ASC-CPL for calendar year 2026.

Cardiovascular Codes

  • Electrophysiology Studies and Ablations: 93619, 93620, 93624, 93642, 93650, 93653, 93654, 93656 and 93724
  • Cardioversion and Transesophageal Echocardiogram: 92960, 93312 and 93318
  • Percutaneous Coronary Intervention (PCI): C9602, C9604 and C9607

Spine Codes

  • Posterior Lumbar Interbody Fusion: 22630
  • Combined Posterior Lumbar and Posterior Lumbar Interbody Fusion: 22633

Vascular Code

  • Vascular Embolization or Occlusion: 37244

Cardiology Codes

ASCA has seen an increase in outpatient cardiovascular care in recent years, largely influenced by CMS’ decision to expand the number of cardiovascular procedures that are eligible for the ASC setting, especially PCIs. Cardiology CPT and Healthcare Common Procedure Coding System (HCPCS) codes experienced fee-for-service Medicare ASC volume growth in 2022, in particular cardiac catheter (93458), PCI (C9600), pacemaker (33208) and cardiac rhythm monitor (33285) codes.

The Heart Rhythm Society (HRS) recently presented data to CMS that support 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 demonstrated that catheter ablations performed in ASCs and HOPDs 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.

ASCA aligned its cardiac ablation requests with those submitted by HRS and the American College of Cardiology. ASCA will continue to work with the specialty organizations to encourage the migration of these codes to the ASC setting.

Spine Codes

In addition to the cardiology codes, ASCA requested again that CMS add CPT codes 22630 and 22633 be added to the ASC-CPL. Doing so would provide Medicare beneficiaries with the option of selecting an ASC setting for their outpatient spine surgery procedure if their surgeon determines it to be the most medically appropriate option. For at least 15 years, commercially insured patients have had the option to select an ASC for their lumbar interbody fusion surgery (either 22630 or 22633).

Numerous peer-reviewed published studies have confirmed the safety and efficacy of outpatient lumbar interbody fusion surgery. Freeway Surgery Center, in Little Rock, Arkansas, enrolled as a temporary hospital through the Hospitals Without Walls program in May 2020 during the COVID-19 public health emergency (PHE) and was able to compile objective medical safety and outcome data from lumbar interbody fusions in the Medicare age group. Patients were 65 years old and above with a mean age of 73 years old. The data confirmed this same advantage in Medicare-aged patients undergoing lumbar interbody fusion surgery in an ASC.

In addition, 22630 and 22633 are in ambulatory payment classification (APC) group 5116. There are 18 procedures in APC 5116, and currently all the other codes are payable in the ASC setting except 22630 and 22633. Since the other procedures are, according to CMS, clinically similar, it does not make sense that CMS would choose to exclude only these two codes within APC 5116 from the ASC-CPL.

Pre-Proposed Rule Covered Procedures List Recommendation Process

In 2022, CMS added the pre-proposed rule covered procedures list recommendation process to the Code of Federal Regulations at 42 CFR §416.166(d) as a new way for the public to submit codes for consideration. Section 1833(i)(1) of the Social Security Act requires the secretary of the US Department of Health and Human Services to specify surgical procedures that can be performed safely on an ambulatory basis in an ASC. CMS reviews and updates the procedures, collectively referred to as the ASC-CPL, annually, but prior to 2024, there was no formal process for sharing codes for consideration with CMS.

Beginning in 2024, interested parties could recommend procedures for addition to the ASC-CPL. According to the Code of Federal Regulations language, submissions are due by March 1 for consideration for the following calendar year. If CMS determines that the procedure meets the requirements for inclusion, it will propose the code be added to the ASC-CPL for the following year. The proposed payment rule is typically released in early July.

ASCA has taken the lead in advocating for additions to the ASC-CPL, encouraging CMS to expand the list of procedures that ASC clinicians can perform on the Medicare population. Over the past decade, with the help of its members, ASCA has successfully advocated for approximately 150 codes that CMS added to the ASC-CPL, including total shoulder arthroplasty and total ankle replacement in 2024.

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