The Centers for Medicare & Medicaid Services (CMS) released a proposed rule on July 7, 2026, that would revise the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2027 (the “Proposed Rule”).
What the Proposed Rule Would Do
If finalized, the Proposed Rule could give physician-owned ASCs a larger role in Medicare outpatient care, allowing physicians to perform a broader set of procedures in facilities they own, invest in, or manage, rather than sending those cases to hospital outpatient departments. CMS also proposed changes to outpatient and ASC quality reporting and is seeking input on hospital price transparency. These proposed changes may affect how ASCs demonstrate quality, how patients compare sites of care, and how independent physician groups position themselves against hospital outpatient departments.
Why the Proposed Rule Matters
For physician-owned ASCs, the Proposed Rule may present new growth opportunities. More Medicare-covered procedures in the ASC setting could support expanded service lines, new physician recruitment, greater case volume, and stronger competitive positioning against hospital outpatient departments.
For independent physicians , the Proposed Rule could be more than an ASC payment update. It could represent an opportunity to keep more outpatient care in physician-led settings, rather than seeing those cases directed by default to hospital outpatient departments. If CMS finalizes a broad expansion of ASC-covered procedures, independent surgeons and proceduralists may have more room to build, join, invest in, or more fully use ASC platforms that are not controlled by hospitals.
A broader ASC Covered Procedures List does not mean every physician ownership or financial arrangement involving an ASC is permissible. The proposal would not eliminate the need to comply with the federal Anti-Kickback Statute, the Stark Law, Medicare enrollment rules, ASC conditions for coverage, state certificate-of-need laws where applicable, corporate-practice-of-medicine restrictions, payer contracting requirements, and ordinary quality and patient-safety obligations.
Who Should Consider Submitting a Comment
CMS is accepting public comments, which are due by August 31, 2026. The comment process provides an opportunity to explain to CMS, in practical terms, which procedures can safely move to the ASC setting, what operational safeguards are already in place, and why expanding ASC access may benefit Medicare patients and the Medicare program.
Physician stakeholders may wish to:
- Support CMS’s proposal to expand the ASC Covered Procedures List because it could give physicians greater flexibility to choose the right care setting for the right patient.
- Explain how physician-owned ASCs can safely perform additional procedures when appropriate screening, credentialing, anesthesia coverage, emergency transfer protocols, and quality controls are in place.
- Identify specific procedures that CMS should add, keep, or reconsider for the ASC setting, particularly where current technology, clinical practice, and patient-selection tools support safe outpatient performance.
- Urge CMS to avoid overly rigid rules that would prevent physicians from using their clinical judgment.
- Address payment adequacy so that payment rates are sufficient to support the safe performance of ASC services, including appropriate staffing, supplies, implants, equipment, and post-procedure monitoring.
- Address how CMS should evaluate quality and patient safety as more procedures move into ASCs.
How Frier Levitt Can Help
While anyone can submit a public comment at regulations.gov or by mail, the comments that are most likely to carry weight with CMS are those that go beyond general opinions and engage directly with the Proposed Rule’s specific provisions.
Frier Levitt’s Advocacy & Government Affairs practice group regularly helps physicians and physician organizations navigate this process, and can assist by:
- Identifying the specific provisions that matter most to your practice, your specialty, or your membership; and
- Drafting a polished, persuasive comment letter on your behalf that speaks directly to the services affected by the Proposed Rule, anticipates the arguments of opposing stakeholders, and includes the kind of supporting evidence and legal reasoning that CMS is more likely to find persuasive.
If your organization has already begun drafting a comment internally, Frier Levitt can review, strengthen, and refine it before submission. We can also help coordinate with other physician groups or allied organizations so that your comment is part of a broader advocacy coalition, which may have greater influence in the rulemaking process.
With the August 31, 2026 comment deadline approaching, we encourage interested providers and organizations to begin preparing their comments as soon as possible. For more information, contact Frier Levitt to speak with an attorney.
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