2026 AMBULATORY SURGERY CENTER (ASC) PAYMENT SYSTEM AND QUALITY REPORTING (ASCQR) PROGRAM
FINAL RULE REVERSES PROPOSED CUT IN FACILITY FEES FOR CATARACT SURGERY AND INCREASES PAYMENT ABOVE
CY25 PAYMENT RATE
2026 ASC Conversion Factor of $56.322 for
ASCs Meeting Quality Reporting Requirements
Today, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates final rule, along with an accompanying fact sheet. The policies are effective beginning January 1, 2026.
CMS Reverses Proposed Rule Cuts to Facility Payments for Cataract Surgery
Following concerns raised by ASCRS, AAO, ASRS, and OOSS, CMS identified an issue that incorrectly calculated the geometric mean cost for procedures that use intraocular lenses. Specifically, their rate-setting programs inadvertently did not import the HCPCS codes that describe intraocular lens devices and disregarded all intraocular lens costs as not related to the OPPS or ASC payment system. Therefore, such IOL costs had not been packaged into the costs of the primary procedure. As a result, the CY26 payment rate for cataract surgery, CPT 66984, is estimated to be $1,255.73 as compared to the CY25 payment rate of $1,214.31.
ASC Conversion Factor
For CY 2026, CMS finalized its proposal to adjust the CY 2025 ASC conversion factor ($54.895) by the final wage index budget neutrality factor of 1.0000 in addition to the finalized productivity-adjusted hospital market basket update of 2.6%, which results in a final CY 2026 ASC conversion factor of $56.322 for ASCs meeting the quality reporting requirements.
For ASCs not meeting the quality reporting requirements, CMS has finalized its proposal to adjust the CY 2025 ASC conversion factor ($53.828) by the final wage index budget neutrality factor of 1.0000 in addition to the reduced productivity-adjusted hospital market basket update of 0.6%, which results in a CY 2026 ASC conversion factor of $55.224 for ASCs not meeting the quality reporting requirements.
ASC Market Basket Update
For CY26, CMS finalized its proposal to extend utilization of the hospital market basket update as the update factor for the ASC payment system for one additional year, through CY 2026, while CMS continues to study the migration of outpatient surgical procedures.
Non-Opioid Treatments for Pain Relief to be Paid Separately in Both the ASC and HOPD Settings
Previously, CMS finalized a policy that non-opioid pain management drugs or biologicals that function as a supply in a surgical procedure are eligible for separate payment if the drug or biological does not have transitional pass-through payment status and is not already separately payable in the OPPS or ASC payment system. CMS will continue this policy for CY 2026. As a result, Omidria (J1097) and Dextenza (J1096) will continue to receive separate payments in the ASC and HOPD settings. CMS finalized its proposal to continue to implement statutory payment limitations under which the additional payment may not exceed an estimated 18% of the OPPS payment for OPPS service or group of services with which the non-opioid treatment is provided.
Under these provisions, CMS has finalized five drugs and six devices to qualify as non-opioid treatments for pain relief. These products are to be paid separately in both the HOPD and ASC settings for CY 2026, including Omidria (J1097) and Dextenza (J1096). Payment limitations for these two drugs are:
- Omidria (J1097) payment limitation: $414.05
- Dextenza (J1096) payment limitation: $419.57
ASC Quality Reporting (ASCQR) Program
The ASCQR Program is a pay-for-reporting quality program for the ASC setting. The ASCQR Program requires ASCs to meet program requirements or receive a reduction in their annual fee schedule update.
CMS did not make any changes to the Cataracts: Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery (ASC-11) measure, which will remain voluntary in 2026. ASCRS strongly opposes the inclusion of this measure and will continue to work to ensure that the reporting does not become mandatory in the future.
Measure Removals
CMS has finalized the removal of the following measures beginning with the indicated ASCQR performance years:
Beginning with the 2024 Reporting Period/2026 Payment Determination:
- COVID–19 Vaccination Coverage Among Health Care Personnel (HCP)
Beginning with the 2025 Reporting Period/2027 Payment Determination:
- Facility Commitment to Health Equity (FCHE)
- Screening for Social Drivers of Health (SDOH)
- Screen Positive Rate for SDOH
For the removal rationale, CMS cites removal Factor 8: the costs associated with achieving a high score on the measure outweighing the benefit of its continued use in the program.
New Measure Proposal Not Finalized
In a huge win for our advocacy efforts, CMS has decided not to finalize their proposal to add a new patient survey measure to the ASCQR.
As proposed, this measure would have required ASCs to distribute (via email or text) a new 9-item patient survey 2–7 days post-op for all patients aged 18 years or older who had a procedure (surgical or non-surgical) at the ASC. This measure would also have become mandatory by 2029, creating a huge burden on ASCs.
Extraordinary Circumstance Exception (ECE)
CMS has finalized an update to the ASCQR ECE policy to clarify that CMS has the discretion to grant an extension in response to an ECE request. In addition, CMS may grant an ECE to one or more facilities that have not requested an ECE if CMS determines that:
- A systemic problem with a CMS data collection system directly impacted the ability of the facility to comply with a quality data reporting requirement, or
- That an extraordinary circumstance has affected an entire region or locale.
In response to our concerns with CMS’s proposal to limit the application deadline to only 30 days after the extraordinary circumstance, CMS has modified the finalized policy to extend this to 60 days after the extraordinary circumstance.
Additional Details to Come
ASCRS is reviewing the final rule, and additional information will be detailed in upcoming editions of Washington Watch Weekly.
