ASC Reimbursements and Strategic Pressures Shape 2026 Outlook

Ambulatory Surgery Centers (ASCs) face significant reimbursement challenges heading into 2026 despite recent payment updates. The 2026 ASC conversion factor is set at $56.322, substantially lower than the $91.415 for hospital outpatient departments, highlighting continuing structural disparities. Centers are particularly pressured on profitability for high-cost and implant-heavy procedures, leading to strategic cost management efforts including vendor negotiations, device standardization, and optimizing scheduling and capital planning. Payers are increasingly resistant to covering newer devices and pharmaceuticals, resulting in more ASCs dedicating resources to appeals and contract renegotiations, especially concerning Medicare Advantage plans. The expansion of ASCs into more complex procedures with longer anesthesia times is further strained by rising labor costs and declining reimbursements, necessitating renegotiated anesthesia contracts and tighter financial coordination. The Ambulatory Surgery Center Association (ASCA) is advocating for CMS to expand covered procedures, especially in cardiac and spine areas, and to consider physician clinical judgment more heavily in site-of-care decisions. While supporting safety and quality reporting, ASCA opposes overly burdensome reporting requirements that could limit provider participation. These dynamics reflect ongoing fiscal and regulatory pressures shaping the ASC market environment in 2026.