Ambulatory Surgery Centers and Medicare Payment Policy for Calendar Year 2027: Impact on Interventional Pain Management.

Authors

Laxmaiah Manchikanti, Mahendra R Sanapati, Vidyasagar Pampati, Ramarao Pasupuleti, Alexander Bautista, Amol Soin, Annu Navani, Alan D Kaye, Rajesh Naidu Janapala, Mayank Gupta, Alaa A Abd-Elsayed, Joshua A Hirsch

Published in

Pain physician. Volume 29. Issue 6. Pages E469-E480.

Abstract

Ambulatory surgery centers (ASCs) have become a common site of service for interventional pain management (IPM) procedures over the past three decades, driven by lower costs, physician ownership incentives, and a permissive regulatory environment. Medicare payment policy for ASCs has evolved through repeated rulemaking cycles since the original 1982 ASC payment system, with each cycle reshaping which procedures may be performed in the ASC setting and their relative payment. On July 2, 2026, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2027 Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System proposed rule (CMS-1850-P), representing the latest development in this continuum.
To review the historical evolution of ASC payment policy relevant to interventional pain management and provide a detailed analysis of the CY 2027 OPPS/ASC proposed rule, its projected impact on IPM procedure reimbursement, and its implications for the survival of independent interventional pain practices.
A narrative policy review was conducted using the CY 2027 OPPS/ASC proposed rule (CMS-1850-P; Federal Register, July 2026), CMS fact sheets and impact tables, and prior peer-reviewed analyses of ASC payment policy published in Pain Physician.
The 2.4% ASC payment update, reflecting a 3.2% market basket update less a 0.8-percentage-point productivity adjustment, is offset for some services by changes in relative payment weights, resulting in substantial variation in payment changes across individual procedures. CMS also proposes continuing, for an additional year, the use of the more favorable hospital market basket rather than the consumer price index as the ASC update factor. Device-intensive, neuromodulation-related codes central to interventional pain practice, including SCS generator insertion (+14.8%), peripheral nerve stimulator electrode implantation (+9.8%), and sacral neuromodulation (+8.0%), receive substantial proposed increases; however, these increases are muted by unfavorable changes incorporating multiple procedure discounts, ultimately resulting in payment reductions when multiple procedures are performed. Minimally invasive sacroiliac joint fusion (+7.1%) and basivertebral nerve ablation (+6.5%) also receive substantial proposed increases. In contrast, core injection-based procedures, including interlaminar and transforaminal epidural steroid injections, facet joint injections, and facet joint radiofrequency ablation, are proposed to decrease by 3.8% to 4.3%. Prior authorization requirements continue to apply to selected procedures in hospital outpatient departments but not in ASCs, and CMS proposes expanding prior authorization requirements for HOPDs to additional botulinum toxin codes, effective July 2027.
This analysis is based on a proposed rule; CMS may materially alter payment rates, covered-procedure additions, and policy provisions in the CY 2027 OPPS/ASC final rule, expected in approximately November 2026. Code-specific rates cited here are derived from CMS impact tables and specialty-society analyses of the proposed rule, rather than from the final Addenda AA/B.
The CY 2027 proposed rule continues a payment trajectory that is relatively favorable to device-based, procedural IPM performed in ASCs compared with hospital outpatient departments, while core injection-based services continue to experience slow, compounding erosion in relative payment. However, proposed multiple-procedure discounting may substantially offset increases in neuromodulation and other device-intensive procedures when multiple procedures are performed during the same session. Practices should evaluate service-line composition, maintain compliance with the ASC Quality Reporting (ASCQR) Program, prepare for the scheduled 2028 non-opioid payment cliff, and submit comments during the rulemaking period.

PMID:
42804299
Bibliographic data and abstract were imported from PubMed on 29 Sep 2026.

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