Medicare ASC-CPL Recommendation Request Closes Soon

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Medicare ASC-CPL Recommendation Request Closes Soon

Now is the time to advocate for additions to the list for 2026

BY KARA NEWBURY | FEBRUARY 14, 2025

The deadline to submit codes for addition to the ASC Covered Procedures List (ASC-CPL) for 2026 rulemaking is March 14. However, ASCA plans to submit by the March 1 deadline included in the Code of Federal Regulations (CFR) at 42 CFR §416.166(d). For 2025 rulemaking, the Centers for Medicare & Medicaid Services (CMS) implemented the ASC-CPL Pre-Proposed Rule Recommendation Request, a new way to submit codes for consideration.

Overview

Section 1833(i)(1) of the Social Security Act requires the secretary of the US Department of Health and Human Services (HHS) to specify surgical procedures that can be performed safely on an ambulatory basis in an ASC. CMS reviews and updates the procedures, collectively referred to as the ASC-CPL, annually, but prior to 2024, there was no formal process for sharing codes for consideration with CMS.

ASCA has taken the lead in addressing this issue, encouraging CMS to add codes to the ASC-CPL that ASC clinicians are performing safely on the Medicare population in the surgery center setting. Over the past decade, with the help of its members, ASCA has successfully advocated for approximately 150 codes that CMS added to the ASC-CPL, including total shoulder arthroplasty and total ankle replacement in 2024.

Over the years, ASCA has solicited feedback from members to determine which codes should be pursued. ASC surgeons have presented to CMS medical officers on the safety of specific codes. Although this process is time-consuming, it has been the most successful way to get codes added to the ASC-payable list.

While ASCA will continue to use this process to pursue codes that are requested the most by its members, it appreciates CMS’ new pre-proposed rule recommendation process, and will use every avenue possible to advocate for additions to the ASC-CPL.

2025 Rulemaking

While CMS is not required to publish all codes requested but only those that the agency chooses to propose for addition, ASCA had asked CMS to be more transparent with the process and publish any requested procedures for which they receive supporting documentation. However, CMS did not mention any of the requested codes in the 2025 proposed rule. In the final rule, CMS did mention that procedures had been requested, including those ASCA requested, but the agency did not respond to each code individually and instead grouped its response.

Regarding cardiovascular codes, including cardiac ablations, cardioversion, electrophysiological studies and procedures, and echocardiography, CMS claimed, “Many of these codes have associated inpatient admissions, where the beneficiary requires active medical monitoring and care at midnight following the procedure. The cardioversion and echocardiography codes are nonsurgical procedures, which means they would not qualify for addition to the ASC CPL, and most of the ancillary codes are not integral to a covered surgical procedure on the ASC CPL.”

CMS also referenced requested musculoskeletal codes (arthrodesis procedures), indicating that “while these procedures have some claims volume in the outpatient setting, the claims also showed multiple postoperative inpatient days, indicating that the beneficiary would require active monitoring and care past midnight following the procedure. These procedures can also involve prolonged invasion of body cavities. In addition, we acknowledge the findings of studies that commenters provided related to these procedures. However, the studies we received had significant limitations, including selection bias and an absence of age groups representative of the Medicare population.”

ASCA disagrees with CMS’ responses and will continue to work with the appropriate specialty organizations and facilities performing these procedures to advocate for the addition of these codes. In 2021, in the final rule of the first Trump administration, CMS added hundreds of codes to the ASC-CPL before removing them in 2022 rulemaking. For 2026, ASCA will advocate for the addition of all the procedures its clinicians are able to perform safely in the outpatient setting.

Pre-Proposed Rule Covered Procedures List Recommendation Process

In 2022, CMS added the pre-proposed rule covered procedures list recommendation process to the CFR at 42 CFR §416.166(d). Beginning in 2024, interested parties could recommend procedures for addition to the ASC-CPL. According to the CFR language, submissions are due by March 1 for consideration for the following calendar year. If CMS determines that the procedure meets the requirements for inclusion, it will propose the code be added to the ASC-CPL for the following year.

Registration

To submit codes for consideration, an ASC must register as a MEARIS user. This process allows all interested stakeholders the opportunity to submit codes for consideration through the MEARIS application system. The registration process is quick and straightforward; plug in your name and email address, choose a security question and answer, and provide a password.

Once you have an account, complete your ASC-CPL Pre-Proposed Rule Recommendation Request. You also will have the flexibility to save your work and come back to the application at a later time.

Submission Process

Once you find the application, titled ASC-CPL Pre-Proposed Rule Recommendation Request, enter the codes you are requesting for addition. CMS also included on the form an option to request a code for removal from the ASC-CPL, so please verify you are requesting codes to be added, not removed.

Next, you will be asked if the codes requested meet the regulatory criteria at 42 CFR §416.166(b). This includes the general standards that the surgical procedure

  • must be eligible for payment under the hospital outpatient prospective payment system (OPPS);
  • must not be expected to pose a significant safety risk to a Medicare beneficiary when performed in an ASC; and
  • is not one for which standard medical practice dictates that the beneficiary would typically be expected to require active medical monitoring and care at midnight following the procedure.

Additionally, procedures are not likely to be placed on the ASC-CPL if they meet any of the following specific exclusions at 42 CFR §416.166(c):

  1. generally result in extensive blood loss
  2. require major or prolonged invasion of body cavities
  3. directly involve major blood vessels
  4. are generally emergent or life-threatening in nature
  5. commonly require systemic thrombolytic therapy
  6. are designated as requiring inpatient care
  7. can only be reported using a CPT unlisted surgical procedure code
  8. are otherwise excluded under §411.15

ASCs will have the opportunity to provide any supporting documentation or information. While this is not required, the more outcomes or quality information, research and volume data an ASC can provide showing they are currently performing these procedures successfully on other patient populations, the more compelling its case will be. ASCA has also had success in the past when highlighting examples of similar procedures that are already included in the ASC-CPL.

Upon submission, the system will confirm receipt. CMS might request additional information and/or documentation regarding a submission via a request for information (RFI). This request will show up as a task on the homepage and sent via email about the “Task Due.”

While interested parties will still be able to submit comments in response to the CY 2026 ASC proposed rule during the public comment period, this pre-rulemaking process is the best opportunity for ASCs to have their codes added to the ASC-CPL.

ASCA currently is focused on the cardiac ablation and lumbar fusion codes that it submitted last year but is open to other suggestions from ASCA members.

Write Kara Newbury at knewbury@ascassociation.org with questions or to propose codes for ASCA’s submission to the portal.