HRA/HRS Urges CMS to Include ASCs in Medicare Coverage for Cardiac Ablation
May 12, 2025
The Honorable Mehmet Oz, M.D., M.B.A.
Administrator
Department of Health and Human Services
Centers for Medicare & Medicaid Services
200 Independence Ave, SW
Washington, DC 20201
Dear Administrator Oz:
We are writing to congratulate you on your new role as the Administrator of the Centers of Medicare & Medicaid Services (CMS). As cardiac electrophysiologists and leaders of the Heart Rhythm Society (HRS) and Heart Rhythm Advocates (HRA), we are excited for your leadership on the Trump Administration’s effort to improve health care quality and delivery for beneficiaries while reducing costs to the American health care system.
Specifically, we would like to bring to your attention an important opportunity to improve the delivery of cardiac electrophysiology (EP) procedures to patients with cardiac arrhythmias. Atrial fibrillation is a leading health issue for Medicare beneficiaries, impacting more than 20% of the general American population at some point in their lives. As the death rate from atrial fibrillation as the primary or contributing cause of death has been steadily rising for over two decades, appropriate access to treatment for cardiac arrhythmias, particularly in the vulnerable Medicare population, is paramount. Catheter ablation has become a mainstay of treatment for atrial fibrillation. With the recent availability of pulsed field ablation and other technologies, the safety of the procedure has greatly improved, making it more accessible to the older Medicare population. With this has come tremendous backlogs and wait times for the procedure, now commonly at 6-9 months.
An opportunity to improve access and reduce costs for AF ablation procedures is to enable performance of cardiac ablations as outpatient procedures in ambulatory surgical centers (ASCs). We recently published clinical data demonstrating that cardiac EP procedures can be safely and effectively performed in the ASC setting with same-day discharge for appropriately selected patients. We would greatly appreciate the opportunity to present this data to you and encourage CMS to add cardiac EP procedure codes to the Covered Procedure List (CPL) this summer in the CY 2026 Hospital Outpatient/Ambulatory Surgical Center Proposed Rule to allow these services to be covered when performed in the ASC setting.
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Currently, cardiac arrhythmia ablation procedures can only be covered for Medicare beneficiaries when performed in the hospital outpatient setting. For Medicare beneficiaries there are not enough hospital EP laboratories across the United States to accommodate the growing backlog of patients in need of cardiac EP procedures, forcing higher wait times for patients in need or preventing access altogether. Given the rising prevalence of arrhythmias, patients need flexibility to have more treatment location options, and permitting cardiac EP procedures to be performed in the ASC setting neatly solves this problem.
We recently published in Heart Rhythm an article on the “Safety and Feasibility of Cardiac Electrophysiology Procedures In Ambulatory Surgery Centers,” based on data from several thousand patients. This data demonstrates that the performance of cardiac EP procedures in the ASC setting is safe. Additional clinical evidence from published literature, meta-analyses and real-world studies supports that cardiac EP procedures are safe for beneficiaries, can be done with same day discharge, and do not require active medical monitoring or overnight care. Further, clinical experience during the Medicare Hospitals Without Walls program, where cardiac EP procedures were covered in the ASC setting for the duration of the COVID-19 public health emergency, supports that safety and outcomes are comparable for cardiac EP procedures performed in the ASC and in hospital settings. Furthermore, cardiac ablations are nowadays performed on an outpatient basis with same-day discharge in many areas around the world.
In addition to enhancing patient access and preference, expanding the CPL to include cardiac catheter ablations would dramatically reduce health care costs for CMS by allowing a more cost-effective medical facility for many patients who do not need to be treated in the hospital setting with overnight observation. The cost of performing procedures in ASCs is generally lower to patients as well as CMS than when performed in hospital outpatient departments. Considering cost savings of 20%, a 5% shift in cardiac ablation volume to ASCs as of 2026 would yield a $160 million reduction in annual payments made by Medicare and Medicare Advantage. Over a 10-year horizon, these savings would easily exceed $3 billion. Thus, for patients who can be appropriately treated in ASCs, performance of cardiac catheter ablations in that setting would not only streamline care, improve access and reduce the protracted backlogs at hospital EP laboratories, but also facilitate cost savings for beneficiaries as well as the federal health care system.
As CMS develops the 2026 Hospital Outpatient/ASC Proposed Rule, we respectfully request that the agency propose adding cardiac EP procedures to the ASC CPL and include the codes in the Proposed Rule for public comment. We would appreciate an opportunity to meet with you to discuss this tremendous opportunity to improve access to cardiac EP procedures for beneficiaries in a way that is safe and cost-effective.
Thank you for your consideration of the cardiac EP codes and we look forward to your leadership at CMS.
Sincerely,
Kenneth A. Ellenbogen, MD, FHRS
Co-Chair, Heart Rhythm Advocates
Andrea Natale, MD, FHRS
Co-Chair, Heart Rhythm Advocates
Mina K. Chung, MD, FHRS
President, HRS
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Dhaval Desai and Said Hajouli, Arrhythmias, National Library of Medicine (June 5, 2023), https://www.ncbi.nlm.nih.gov/books/NBK558923/.
Centers for Disease Control and Prevention, About Atrial Fibrillation (May 15, 2024), https://www.cdc.gov/heart-disease/about/atrial-fibrillation.html.
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See, e.g., Persson R, Earley A, Garlitski AC, Balk EM, Uhlig K. Adverse events following implantable cardioverter defibrillator implantation: A systematic review. J Interv Card Electrophysiol 2014;40:191-205; Li K, Kalwani NM, Heidenreich PA, Fearon WF. Elective percutaneous coronary intervention in ambulatory surgery centers. JACC Cardiovasc Interv 2021;14:292-300; Goldfarb CA, Bansal A, Brophy RH. Ambulatory surgical centers: A review of complications and adverse events. J Am Acad Orthop Surg 2017;25:12-22.
Aryana A, Thihalolipavan S, Willcox ME, et al. Safety and Feasibility of Cardiac Electrophysiology Procedures In Ambulatory Surgery Centers, Heart Rhythm 2025;22:717-724.
