CMS Final Rule Delivers Landmark Win: EP Ablations Added to ASC-Covered Procedures List for CY 2026
In a milestone decision for the electrophysiology community, the Centers for Medicare & Medicaid Services (CMS) finalized the CY 2026 Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) Payment System rule and, for the first time, approved key cardiac catheter ablation procedures for performance in ASC settings.
Effective January 1, 2026, CMS has added several cornerstone EP ablation codes, including 93650, 93653, 93654, 93656, and related add-on codes, to the ASC-Covered Procedures List (ASC-CPL). This change expands Medicare beneficiary access to EP services and represents one of the most significant federal advancements in how and where EP care is delivered in more than two decades.
Historically, Medicare allowed EP ablations only in hospital outpatient departments, largely due to concerns about complexity and whether ASCs could support these procedures safely. In the 2026 final rule, CMS recognized how much the field has advanced, including better safety data, more efficient workflows, and major improvements in technology, and concluded that EP ablations are now appropriate for the ASC setting. All primary ablation procedures were assigned J8 device-intensive payment indicators, ensuring full recognition of the equipment and resources required when performed in ASCs.
Heart Rhythm Advocates (HRA), Heart Rhythm Society (HRS), and partner stakeholders have long pressed for expansion of permissible sites of service for EP ablation, backed by emerging clinical evidence, ASC outcome data, technological improvements, and early experiences from private-payer environments. While prior CMS rulemaking cycles rejected similar requests, often categorizing EP ablations as “non-surgical” or insufficiently supported for ASC performance, the 2026 decision reflects a meaningful policy shift and recognition of the modern electrophysiology ecosystem.
“This CMS decision is a tremendous victory for our field and the patients we serve,” said HRA Board Co-Chair Dr. Kenneth Ellenbogen, MD, FHRS. “Adding EP ablations to the ASC-Covered Procedures List is the clearest recognition yet of just how far electrophysiology has come - in safety, in quality, and innovation. This is a moment our community has worked toward for years, and it reflects the dedication of countless clinicians, advocates, and partners who believed this progress was possible. HRA is proud to have played a central role in this achievement, and we look forward to helping EP teams across the country seize the opportunities this milestone creates.”
"CMS’s final rule is more than a policy update; it’s a real turning point for the EP community,” added HRA Co-Chair Dr. Andrea Natale, MD, FHRS. “Bringing ablations into the ASC environment validates years of clinical progress and the dedication of teams who have pushed the boundaries of what safe, high-quality outpatient care can look like. This decision opens the door to new models of care, greater flexibility for clinicians, and faster access for patients who have been waiting for advanced treatment options.”
The impact of CMS’s decision will be wide-ranging. Facilities with appropriate infrastructure, including physician-owned and hospital-owned ASCs, may begin offering EP ablations to Medicare beneficiaries, expanding geographic and scheduling access and reducing system bottlenecks. CMS’s approval acknowledges that modern EP ablation workflows, mapping systems, anesthesia protocols, and facility designs can meet federal safety expectations traditionally associated with HOPDs.
Importantly, CMS retained full device-intensive status for EP ablations under HOPPS, with no packaging or APC downgrades. Hospitals performing high volumes of EP care will continue to receive stable technical reimbursement.
Not all cardiovascular or electrophysiologic services were approved for ASC performance. CMS did not add a group of related diagnostic or non-surgical cardiovascular services, including stand-alone electrophysiologic studies without ablation, transesophageal echocardiography (TEE), and certain pre-procedural imaging and planning codes, which remain hospital-only services. CMS clarified that these remain classified as “non-surgical” and are therefore ineligible for stand-alone ASC approval, although some may be used as ancillary services when paired with ASC-approved primary procedures.
HRS and HRA staff are analyzing the full 1,657-page rule (including technical payment tables, quality program updates, device-intensive calculations, and facility requirements) to prepare detailed guidance for clinicians, administrators, and ASC operators.
CMS’s decision marks the beginning of a new era in EP access and practice models. As the field continues to evolve, HRS and HRA will remain deeply engaged with CMS, commercial payers, and policymakers to ensure that innovation, safety, and patient access advance together.
Further updates will be provided as full analysis of the final rule continues.