It’s midsummer, which means it’s time for CMS to release 1000-plus pages of proposed rules that could shape your 2026 strategy.

The ambulatory surgery center experts at Compass Surgical Partners have zeroed in on the biggest takeaways to help physicians and health systems make sense of what’s coming.

Background: CMS has released its proposed updates to the Physician Fee Schedule (PFS) and the Outpatient Prospective Payment System (OPPS) for 2026, which the agency will finalize in November. These rules dictate how Medicare will reimburse ASCs, HOPDs, and physician services, and they often set the pace for commercial payer trends.

The 2026 proposal opens the door for more procedures in ASCs, puts more decision-making power in physicians’ hands, and signals a continued push toward lower-cost surgical settings.

IPO List on the Way Out

The proposed rule takes the first big step in a planned three-year phase-out of the Inpatient-Only (IPO) list, beginning with the removal of 285 procedures in 2026 — most of them musculoskeletal.

CMS first proposed eliminating the Inpatient-Only (IPO) list in 2021, but paused the effort in 2022. Now, in the 2026 proposed rule, the agency is revisiting IPO elimination with a gradual, three-year approach.

ASC-CPL Gains 547 New Codes for 2026

Thanks to advances in technology, anesthesia, and surgical techniques, many procedures that were once considered too complex for outpatient settings can now be performed safely and efficiently in ASCs. Reflecting this evolution, CMS has proposed adding 547 new codes to the ASC Covered Procedures List (ASC-CPL) for 2026.

Highlights include:

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Site-of-Service: More Power to Physicians

By eliminating the IPO list over three years and expanding next year’s ASC-CPL by 547 codes, CMS is giving surgeons more control over where procedures take place, and offering patients more options.

“We support the elimination of the IPO list as it improves patient access, lowers cost for patients and Medicare, and puts the site-of-service decision in physicians’ hands,” says Compass Vice President of Payer Strategy, Stacy LaLonde.

“ASCs provide high-quality care and offer a high degree of patient satisfaction,” LaLonde adds. “Starting with the 285 mostly musculoskeletal procedures added to the ASC-CPL for 2026, the proposed rule offers exciting opportunities for our physician and health system partners across our ASC portfolio.”

Health System Strategy: ASC Partnerships More Essential Than Ever

As CMS rulemaking accelerates long-standing trends toward ambulatory surgical care, health systems without ASC infrastructure face mounting risks, not just in lost case volume, but also in losing top surgical talent.

“ASCs are no longer just a competitive edge for health systems,” says Abdul Eljabaly, Director of Health System Strategy at Compass. “They’re a strategic necessity.”

“Health systems that want to grow surgical service lines — and recruit and retain leading physicians — need to be thinking seriously about ASC partnerships,” he adds.

With the right ASC development and management partner, health systems can move quickly to build the infrastructure, governance, and alignment needed to thrive in this rapidly shifting landscape, without compromising quality or physician engagement.

Learn More: Health Systems Are Doubling Down on Ambulatory Surgical Care – Here’s Why

ASC Ownership Can Help Physicians Thrive as Professional Fees Stagnate

CMS’s proposed 2026 PFS includes a modest bump in professional fee reimbursement —but it’s nowhere near enough to offset the rising administrative costs and staffing challenges that medical groups face.

For physicians, the takeaway is clear: ASC ownership continues to be one of the most effective ways to stabilize income, build diverse revenue streams, and gain more control in a shifting healthcare landscape.

Explore ‘The Case for Generating Growth with an ASC Management Company,’ by Scott Bacon and Madeleine Harrigan.

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