A Pivotal CMS Shift
On July 15, 2025, CMS released the CY 2026 OPPS/ASC Payment System Proposed Rule, recommending that common electrophysiology (EP)ablation procedures—including atrial fibrillation, ventricular tachycardia, and AV node ablations—be added to the Ambulatory Surgical Center (ASC) Covered Procedures List starting January 1, 2026.
If finalized, Medicare will reimburse these procedures when performed in ASCs, shifting cases that have historically been billed as high-cost inpatient or hospital outpatient services into a more cost-efficient, physician-controlled environment.
The Financial Impact
Moving ablations to ASCs is more than just a change in site of service—it’s a structural cost reset for both patients and the healthcare system.
For Patients
- Lower co-pays and coinsurance: Typical hospital outpatient facility fees for ablations can exceed $25,000–$30,000 before physician fees. In an ASC, total facility charges are often 30–50% lower, directly reducing patient out-of-pocket expenses.
- Fewer hidden costs: Hospital-based care often includes higher ancillary charges for imaging, labs, and recovery; ASCs streamline these costs and eliminate waste.
For the Health System
- Medicare savings: CMS pays a lower facility rate in ASCs—often 40–50% less than HOPD rates—for the same CPT code. Across tens of thousands of annual ablations, this could mean hundreds of millions in annual Medicare savings.
- Employer and commercial payer relief: Private insurers typically peg their payments to Medicare’s site-based differential, creating downstream cost reductions for employers and the commercially insured.
- Better capacity utilization: Shifting lower-acuity cases to ASCs frees up hospital capacity for complex, higher-acuity care that requires inpatient resources.
Access and Patient Experience Advantage
While lower costs are a major benefit, they are only one part of the story. Many cath/EP labs in the U.S. face growing backlogs driven by rising atrial fibrillation prevalence, earlier adoption of ablation in guideline-directed therapy, limited lab rooms shared with PCI/structural heart cases, and persistent shortages of cath‑lab nurses and technologists. Nationally, demand for EP procedures is projected to grow by over 5% annually, yet hospital lab capacity is growing far slower. Patients often wait weeks or months for treatment, and hospital-based care can involve less convenient access with more administrative hurdles.
Shifting appropriate cases to ASCs changes this dynamic, relieving pressure on overcrowded hospital labs and bringing care into smaller, more efficient settings closer to patients. It reduces day‑of‑surgery cancellations due to hospital emergencies, and shortens queues for elective ablation. In practical terms, hospital labs can focus on high‑acuity cases while ASCs maintain predictable, high‑throughput schedules—cutting wait times from months to weeks in many markets, enabling earlier intervention, reduced symptom burden, and improved long-term outcomes.
In this context, ASC-based EP care offers directly to patients:
- Shorter wait times for procedures.
- Same-day discharge with less disruption to patients’ and families' lives.
- Streamlined care pathways that reduce complications and readmissions.
Opportunity for Cardiovascular Physicians
This shift doesn’t just benefit patients—it also changes the game for cardiovascular specialists in multiple ways:
- Increased financial viability: With ablations now reimbursable in ASCs, physicians can anchor their centers around high-demand, high-value procedures without relying on hospital employment. This makes private ownership models far more sustainable.
- Access to advanced technology: Physicians can select and implement the latest diagnostic and therapeutic tools based on clinical judgment, without delays or restrictions caused by large-hospital administrative processes
- Greater revenue retention: Instead of hospital systems capturing the majority of procedural value through facility fees, more of that revenue remains with the physician-led enterprise. This can fund investments in growth, technology upgrades, and improved staff compensation.
- More strategic leverage: Payers value cost-effective, high-quality networks. Offering the same procedure at significantly lower total cost strengthens a practice’s bargaining position and can open doors to preferred contracting and value-based arrangements.
- Expanded clinical autonomy: Running an ASC allows physicians to control scheduling, staffing, and protocols, enabling them to align operations directly with patient care priorities. This can also create a more efficient, fulfilling work environment for the entire clinical team.
- Practice growth opportunities: Lower costs and improved patient access can increase procedural volumes, supporting expansion into additional cardiovascular services and ancillary programs.
Bottom Line: CMS’s proposed change to reimburse EP ablations in ASCs will cut costs for patients, save the health system hundreds of millions. The combination of cost savings, efficiency, and quality makes this a rare “win-win-win” for all stakeholders.
it also opens a once-in-a-generation opportunity for electrophysiologists to lead care on their own terms. With Atria, that opportunity becomes a sustainable reality.
