2026 Ambulatory Surgery Center (ASC) & Office-Based Surgery (OBS) Outlook

As healthcare continues evolving in 2026, ambulatory care settings such as Ambulatory Surgery Centers (ASCs) and Office-Based Surgery (OBS) practices remain at the forefront of policy, payment, and service delivery changes. With Medicare rule updates, reimbursement shifts, and evolving site-of-service dynamics, providers must understand the landscape to stay compliant, profitable, and competitive.

Medicare Payments Increase Modestly in 2026

In late 2025, the Centers for Medicare & Medicaid Services (CMS) finalized the Calendar Year (CY) 2026 Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Final Rule. For both hospital outpatient departments and ASCs, CMS adopted a 2.6% update to payment rates for providers that meet quality reporting requirements. This update reflects a market basket increase of 3.3% offset by a 0.7% productivity adjustment.

For ASCs, this increase is broadly positive, but the impact varies significantly by procedure code and specialty. CMS also clarified that quality reporting noncompliance will result in a two-percentage point reduction to payment rate updates, underscoring the importance of robust ASC Quality Reporting (ASCQR) participation.

Expansion of the ASC Covered Procedures List

One of the most transformational elements in the 2026 rule is the expansion of the ASC Covered Procedures List (CPL). CMS revised the criteria for adding procedures and added hundreds of codes to the CPL, including codes that were recently removed from the inpatient-only (IPO) list. This gives ASCs the ability to perform and be reimbursed for more complex procedures — including musculoskeletal and other higher-acuity services — that historically were limited to hospital settings.

The phase-out of the IPO list is designed to increase flexibility in site-of-service decisions, allowing patients and physicians to choose less costly settings when clinically appropriate.

Site Neutral and Price Transparency Policies

The 2026 OPPS/ASC Final Rule also includes ongoing site neutral payment policies and price transparency requirements:

• CMS finalized price transparency enhancements requiring hospitals to disclose meaningful, accurate pricing information — including median and percentile allowed amounts — to help patients make informed decisions.

Site neutral policies, including updates to how certain drug administration services are paid in provider-based departments, continue to be refined, potentially shifting volume away from high-cost settings.

These policies reflect CMS’s broader goal of value-based care and cost containment, which may continue to shape outpatient surgical markets in the years ahead.

What This Means for OBS Practices

While much attention centers on ASCs, Office-Based Surgery (OBS) practices are also benefiting from broader outpatient trends:

• Advances in technology, minimally invasive techniques, and physician-led outpatient care models are driving shifts away from traditional inpatient procedures.

• As the healthcare system emphasizes physician-led, lower-cost sites, OBS locations increasingly serve as viable alternatives for procedures that don’t require the full ASC environment, especially in specialties like ophthalmology, dermatology, and minor orthopedics.

Together with ASC growth, OBS highlights how patient demand for convenience and cost savings is influencing where care is delivered.

Trend Toward Lower-Cost, Higher-Value Care

The broader healthcare context for 2026 continues to emphasize value over volume. Payers and regulators are increasingly focused on:

• Aligning payment with quality outcomes

• Reducing unnecessary hospital care utilization

• Encouraging care in outpatient and ambulatory settings when appropriate

Ambulatory care settings — including both ASCs and OBS practices — are well positioned to thrive under these expectations, but success requires strategic planning, compliance readiness, and operational excellence.

Action Steps for ASC/OBS Leaders in 2026

1. Maximize Quality Reporting:
Ensuring full compliance with ASCQR requirements is essential to qualify for full payment updates and avoid rate reductions. Quality data must be accurate, timely, and complete.

2. Expand Service Lines Strategically:
With hundreds of new CPL codes available, facilities should evaluate opportunities to expand procedural offerings safely and profitably.

3. Enhance Price Transparency Efforts:
Prepare for ongoing transparency requirements by standardizing price disclosures and helping patients understand expected costs.

4. Strengthen Site-of-Service Decision Making:
As CMS continues site neutral and IPO list elimination strategies, providers should optimize where procedures are performed based on cost, safety, and patient preference.

Final Thoughts

The 2026 policy landscape presents both opportunities and challenges for ASCs and OBS practices. With moderate reimbursement increases, expanded procedural scope, and greater emphasis on quality and transparency, the sector is rapidly evolving. Savvy leaders should leverage these trends to grow volume, improve care quality, and enhance the patient experience.