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CY 2026 OPPS/ASC Proposed Rule Update: Electrophysiology Impacts

The Centers for Medicare & Medicaid Services (CMS) released the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule, which includes significant changes impacting the field of electrophysiology (EP). These changes reflect CMS's ongoing efforts to promote site neutrality and increase access to high-quality cardiac care in lower-cost outpatient settings.

Key Proposals for Electrophysiology Services

One of the most notable proposals is the addition of several complex ablation procedures to the ASC Covered Procedures List (ASC-CPL). These include:

  • CPT 93650 – AV node ablation

  • CPT 93653 – Supraventricular tachycardia (SVT) ablation 

  • CPT 93654 – Ventricular tachycardia ablation

  • CPT 93655 – Add-on code: Intracardiac catheter ablation of a discrete mechanism of arrhythmia

  • CPT 93656 – Atrial fibrillation (AF) ablation

  • CPT 93657 – Add-on code: Additional ablation

 

If finalized, Medicare would provide reimbursement for these procedures when performed in ASCs. This represents a significant site-of-service shift, particularly for procedures traditionally performed in hospital inpatient or outpatient departments. The change could enable greater access to care and reduce costs for patients and the healthcare system. However, it also underscores the need for careful patient selection and attention to safety protocols in non-hospital settings.

 

Expanded List of Proposed Additions

In addition to the above ablation procedures, CMS also proposes to add:

  • CPT 33244 – Removal of a single or dual chamber implantable cardioverter-defibrillator (ICD) lead(s)

  • CPT 33272 – Removal of a subcutaneous ICD electrode

  • Category III Codes 0515T–0520T – Used to report advanced cardiac resynchronization therapy (CRT) procedures, including innovative conduction system pacing techniques such as left bundle branch area pacing and associated lead placement/removal services

 

Including these procedures on the ASC-CPL further reflects CMS’s recognition of evolving technology and the growing capability of ASCs to manage complex EP interventions safely and efficiently.

 

Additional Regulatory and Reimbursement Updates

The proposed rule also outlines:

  • Payment Rate Updates: Adjustments to OPPS and ASC payment rates that may affect overall reimbursement for EP services across both settings

  • Revised Status Indicators: These help clarify how services will be paid (e.g., packaged, separately payable, or conditionally bundled)

  • Inpatient-Only (IPO) List Removals: Continued removal of procedures from the IPO list, supporting the shift to outpatient management for complex cardiac conditions

 

These developments collectively support the migration of cardiac procedures—including advanced EP studies and interventions—from inpatient to outpatient and ASC environments.

 

Stakeholder Engagement

Heart Rhythm Advocates is actively reviewing the proposed rule and preparing formal comments to CMS. EP physicians, administrators, and other stakeholders are encouraged to:

  • Analyze how these changes may impact care delivery, reimbursement, and operational planning

  • Submit individual or organizational comments to CMS by September 15, 2025, via the Federal Register portal.

 

Final Thoughts

While the proposed rule offers exciting opportunities to expand access and reduce the cost of EP care, it also introduces important considerations around safety, care coordination, infrastructure readiness, and long-term outcomes. Ensuring that these policies are implemented in a way that preserves clinical integrity and supports optimal patient care will require thoughtful input from the EP community.

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