On November 21, 2025, CMS released the CY 2026 OPPS and ASC Final Rule, CMS-1834-FC. The headline number is a 2.6% ASC payment update, a 3.3% market basket increase reduced by a 0.7% productivity adjustment. Total ASC payments are projected at $9.2 billion for 2026. The harder-to-summarize items are the ones that change what ASCs do, not just what they get paid.
The ASC Covered Procedures List expansion
CMS added 560 surgical procedures and 35 ancillary services to the ASC Covered Procedures List for CY 2026. The mechanism behind the expansion matters as much as the number: CMS removed 5 of the regulatory exclusion criteria that had historically kept procedures off the list, explicitly shifting clinical judgment about appropriateness to the operating physician on a case-by-case basis.
The practical implication is that the universe of procedures an ASC can perform is now larger than the universe most centers are credentialed and equipped to perform. The gating function moves from the regulation to the medical staff.
What this means for privileging
Privileging files for surgeons performing newly eligible procedures need to reflect training, experience, and outcomes for those procedures specifically. The expansion is not a license to schedule any procedure on the new list, it is a license for the medical staff to make those decisions deliberately. The documentation should make the deliberation visible.
The Inpatient-Only List sunset
CMS finalized a three-year phase-out of the Inpatient-Only List, ending January 1, 2028. For CY 2026, 285 mostly musculoskeletal procedures come off the list, in addition to 16 non-musculoskeletal procedures removed in prior cycles.
The IPO sunset does not automatically move procedures to the ASC setting, it removes the regulatory bar to outpatient hospital performance, with ASC eligibility following the separate ASC-CPL process. The two policies interact, and the interaction is where case planning gets complicated.
What this means for case selection
Total joint, complex spine, and other procedures previously locked to inpatient are now part of an active conversation about appropriate setting. ASCs taking on these cases need explicit case-selection criteria, anesthesia protocols, recovery pathways, and transfer agreements. CMS is not going to write that policy for you.
Site-neutral payment policy
The Final Rule expands site-neutral payment policy in ways that produce a projected $290 million reduction in payments. The expansion narrows the gap between hospital outpatient and ASC payment rates for additional services. For ASCs, the effect is more competitive parity in some service lines and continued pressure on cost discipline.
ASCQR measure changes
Four measures are removed from the ASC Quality Reporting program:
- COVID-19 vaccination coverage among health care personnel.
- Facility Commitment to Health Equity (FCHE).
- Screening for Social Drivers of Health (SDOH).
- Screen Positive Rate for Social Drivers of Health.
The removals reduce reporting burden but do not necessarily reduce the underlying expectation. Centers that built workflows around SDOH screening should think carefully before retiring those workflows entirely, particularly where state programs, payer contracts, or accreditation standards still expect the data.
What to do in the next 60 days
Map the new ASC-CPL to your current case mix
Identify which newly eligible procedures are realistic candidates for your center based on surgeon expertise, equipment, and patient population. Most centers will pick a small number, three to ten procedures, to evaluate seriously rather than the full 560.
Update privileging workflows
For each candidate procedure, define the privileging criteria. Training, case volume, proctored cases, and outcomes thresholds should be explicit. The medical executive committee should approve the criteria before the first case is scheduled.
Plan training and competency
For staff supporting newly eligible procedures, circulating, scrubbing, anesthesia tech, recovery, define and document the training. Existing competencies will cover some of it. New procedures bring new equipment, new positioning, and new recovery considerations.
Reassess the ASCQR data infrastructure
Decide which removed measures to keep collecting locally and which to retire. The decision is not automatic. Some of these data points feed QAPI, payer reporting, or state programs even after CMS stops requiring them.
Quick win
Pull the 560 newly eligible procedures and filter to the CPT ranges your surgeons already perform in adjacent settings. The filtered list is typically under 30 procedures, and that is the realistic 2026 expansion universe for your center.
The strategic read
CMS is continuing a multi-year shift of surgical volume from inpatient and hospital outpatient toward ASCs, with clinical judgment doing more of the gating work that regulation used to do. The centers that benefit are the ones with strong medical staff governance, disciplined privileging, and credible training records. The centers that struggle are the ones that treat the expansion as a marketing opportunity rather than a governance exercise.
How DocForms helps
Three modules carry the bulk of the CY 2026 implementation work.
- Credentialing and Privileging ties privileging criteria to specific procedures, tracks training and proctored cases, and gives the MEC the evidence it needs to make defensible decisions on newly eligible procedures.
- Learning Management assigns and tracks staff training for new procedures, equipment, and recovery pathways, with competency records that match the case.
- Compliance Logs capture ASCQR data, including measures you choose to keep collecting locally, and link case-level data to QAPI, so the operational record holds up whether CMS, the state, or a payer asks for it.