Medicare’s ASC Covered Procedures List names every surgery Medicare will pay for when it is done at an ambulatory surgery center rather than a hospital. For 2026, CMS loosened the eligibility rules and added roughly 560 new procedure codes, so more surgeries qualify than at any point in the program’s history. The list is published as a spreadsheet on the CMS website, and any five-digit CPT or HCPCS code that appears in it with a payment rate is covered in the ASC setting.
How to Check Whether a Procedure Is Covered
Every surgery on the list carries a five-digit HCPCS or CPT code. Ask the surgeon’s office or the ASC’s billing staff for the code, then look it up in the official CMS addenda files.
CMS posts the covered procedures list as downloadable spreadsheets on its ASC Payment Rates Addenda page.1Centers for Medicare & Medicaid Services. ASC Payment Rates – Addenda Two files matter. Addendum AA lists the surgical procedures with their national payment rates. Addendum BB covers ancillary items such as separately payable drugs and devices.2Centers for Medicare & Medicaid Services. MM14359 – Ambulatory Surgical Center Payment January 2026 Update Download the zip for the current calendar year, open Addendum AA, and search for the code.
Each row shows a payment indicator next to the dollar amount. G2 marks a surgical procedure added to the ASC list in 2008 or later, paid from the OPPS relative weight. J8 marks a device-intensive procedure paid at an adjusted rate that accounts for the cost of an implanted device. N1 marks a packaged service with no separate payment, because its cost is bundled into the primary procedure.
If the code appears with a payment indicator and a rate, it is on the covered list. That confirms how Medicare pays for the procedure, not that any specific patient will be approved. The local Medicare Administrative Contractor makes the final call on medical necessity.2Centers for Medicare & Medicaid Services. MM14359 – Ambulatory Surgical Center Payment January 2026 Update
What Changed for 2026
The rules governing which procedures qualify for the list changed on January 1, 2026. Under the framework used from 2008 through 2025, a procedure had to be separately paid under the Outpatient Prospective Payment System and could not fall into any of five categorical exclusions covering extensive blood loss, prolonged invasion of body cavities, major blood vessels, emergency care, or extended recovery.3eCFR. 42 CFR 416.166 – Covered Surgical Procedures
The 2026 rule keeps only four requirements. A procedure must be separately paid under the OPPS, must not be designated as requiring inpatient care, must not be reportable only through an unlisted CPT code, and must not be excluded by federal statute. The five categorical exclusions are gone as automatic bars; CMS converted them into nonbinding safety considerations for the operating physician.4Centers for Medicare & Medicaid Services. Calendar Year 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment Systems Fact Sheet
The change added 289 procedure codes under the relaxed criteria. Separately, CMS began a three-year phase-out of the Inpatient Only list, pulling 285 mostly musculoskeletal procedures off it and making them eligible for the ASC and outpatient settings for 2026. That is roughly 560 new codes payable in ASCs this year.4Centers for Medicare & Medicaid Services. Calendar Year 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment Systems Fact Sheet The Inpatient Only phase-out continues over the next two years, so the list will keep growing. If a patient was told in a prior year that a surgery had to happen in a hospital, it is worth checking whether that code has since moved.
One structural rule did not change. An ASC is defined as a facility that provides surgical services to patients who do not need hospitalization, with an expected duration of services not exceeding 24 hours after admission.5eCFR. 42 CFR 416.2 – Definitions If a procedure’s typical recovery would push past that window, it does not belong in an ASC no matter what the code table says.
What Is Still Excluded
Three categories remain off-limits under the updated regulation.3eCFR. 42 CFR 416.166 – Covered Surgical Procedures
- Procedures still on the Inpatient Only list must be done in a hospital inpatient setting until CMS formally removes them.
- Procedures reportable only through a generic unlisted CPT code will not be paid in an ASC.
- Services barred by federal statute, such as purely cosmetic surgery with no medical purpose, are excluded regardless of setting.
If a procedure is not on the ASC Covered Procedures List, the facility cannot bill Medicare for the facility fee, and the patient could owe the full charge. When an ASC knows or suspects Medicare will not cover a service, it should issue an Advance Beneficiary Notice in writing before surgery so the cost is not a surprise.
The old categorical concerns about blood loss, body cavity invasion, and major vessels no longer automatically block a procedure, but they still matter as clinical judgment. A surgeon who schedules a high-risk case in an ASC when a hospital would be safer is taking on liability even when the code appears on the covered list.
What the Patient Pays at an ASC
Surgery at an ASC produces at least two separate bills. The ASC facility fee covers nursing, recovery room time, anesthetics, drugs, and supplies. The surgeon and anesthesiologist bill independently under the Medicare Physician Fee Schedule for their professional services. Each has its own cost-sharing.
For the facility fee, Medicare Part B pays 80 percent after the beneficiary meets the annual Part B deductible, which is $283 for 2026.6Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles The patient owes the remaining 20 percent as coinsurance. ASC facility fees tend to run lower than hospital outpatient department charges for the same surgery, because ASC relative payment weights for 2026 are set at 87.2 percent of the corresponding OPPS weights.7Federal Register. Medicare Program – Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems The lower facility rate flows through to a lower coinsurance amount for the patient.
Prior Authorization for Five Procedures in Ten States
Starting in 2026, CMS launched a five-year prior authorization demonstration for five ASC procedures the agency considers prone to overuse: blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty, and vein ablation.8Centers for Medicare & Medicaid Services. Prior Authorization Demonstration for Certain Ambulatory Surgical Center Services
Ten states are included. California, Florida, Tennessee, Pennsylvania, Maryland, Georgia, and New York started on January 19, 2026. Texas, Arizona, and Ohio joined on February 16, 2026.9Centers for Medicare & Medicaid Services. Prior Authorization Demonstration for Certain Ambulatory Surgical Center Services FAQs ASCs outside those states are not affected.
Prior authorization here is technically voluntary. CMS does not block the surgery. If the ASC skips it, the claim is flagged for prepayment medical review, which delays payment and raises the risk of denial.8Centers for Medicare & Medicaid Services. Prior Authorization Demonstration for Certain Ambulatory Surgical Center Services When CMS returns a non-affirmed decision finding the service not medically necessary, the ASC should issue an Advance Beneficiary Notice before proceeding, so the patient knows they may owe the full cost.10Centers for Medicare & Medicaid Services. Prior Authorization Demonstration for Certain Ambulatory Surgical Center Services – Operational Guide