CMS Proposes CY 2027 Hospital Outpatient and Ambulatory Surgical Center Payment Policies

On July 2, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule.

The proposed rule includes annual payment updates for hospital outpatient departments and ASCs, continued expansion of procedures eligible for outpatient payment, and changes to outpatient and ASC quality reporting requirements. Several proposals will affect anesthesiologists as more complex procedures and patients move into outpatient settings.

CMS proposes removing 638 services from the Inpatient Only list in CY 2027. The affected services include procedures involving the digestive, respiratory, urinary, endocrine, reproductive, maternity and delivery, mediastinal and integumentary systems. A procedure’s removal from the Inpatient Only list does not require that a service be performed on an outpatient basis. Instead, it allows Medicare payment for the service when the treating physician determines that outpatient care is clinically appropriate. 

Payment eligibility does not necessarily establish that a procedure is appropriate for every ASC. Anesthesiologists are essential in determining patient selection, preoperative optimization, perioperative risk assessment, postoperative recovery, and emergency preparedness. As ASA stated in our 2026 comment letter on this issue, “Decisions about the appropriate facility for care must involve thoughtful, shared decision-making between the anesthesiologist, surgeon, and patient.” 

CMS is seeking comment on several facility-based quality measures. CMS is considering stratifying the ASC All-Cause Hospital Transfer/Admission measure by the phase of care in which the transfer or admission occurred. This is a facility-level measure reported by ASCs through the ASC Quality Reporting Program. The measure is not an individual clinician or Merit-based Incentive Payment System (MIPS) measure reported by anesthesiologists.

CMS also requests information on potentially adopting an advance care planning measure for the Hospital Outpatient Quality Reporting Program. Depending on how the measure is structured, the proposal could affect preoperative workflows and documentation. 

The proposed rule also considers allowing hospital accrediting organizations with Medicare deeming authority to assess hospital compliance with certain administrative Emergency Medical Treatment and Labor Act (EMTALA) requirements. These requirements include signage, maintenance of emergency department logs, transfer records and on-call physician lists. CMS would retain responsibility for enforcement of substantive EMTALA patient-care requirements.

The continued migration of procedures into hospital outpatient departments and ASCs may increase demand for ambulatory anesthesia services while also increasing the complexity of patients and procedures treated in those settings. ASA staff are reviewing the proposed rule and associated procedure lists to identify additional policies affecting anesthesiologists and the safe delivery of anesthesia care.

Comments are due 60 days following publication of the proposed rule in the Federal Register.

Please contact the ASA Department of Quality and Regulatory Affairs at [email protected] with any questions or comments.

For additional details, see:  

• CY 2027 OPPS/ASC proposed rule
• CY 2027 OPPS/ASC proposed rule fact sheet
• CY 2027 OPPS/ASC proposed rule press release