The Centers for Medicare & Medicaid Services (CMS) has released the 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule, outlining a series of policy shifts that will shape how cardiovascular services are delivered and reimbursed in the years ahead.
At Heart & Vascular Partners, we monitor these updates closely because they directly impact patient access, physician autonomy, and the long-term sustainability of cardiovascular programs nationwide. Below is a breakdown of the major changes and what they could mean for providers, practices, and the patients we serve.
The following summary reflects key updates outlined in the American College of Cardiology’s (ACC) initial analysis of the 2026 OPPS and ASC Final Rule.
1. OPPS Payments Increase 2.6%
CMS finalized a 2.6% increase to OPPS payment rates, reflecting a 3.3% market basket update offset by a 0.7% productivity adjustment.
While modest, this increase offers some stability for outpatient cardiovascular programs experiencing persistent inflationary pressure, workforce costs, and growing procedural volumes in the ambulatory setting.
2. Cardiac Ablation Procedures Added to ASC Covered Procedures List
A major development for cardiology: CMS is officially adding cardiac catheter ablations to the ASC Covered Procedures List (CPL).
This is a significant win for the electrophysiology community after years of advocacy from the American College of Cardiology (ACC), Heart Rhythm Society (HRS), and other stakeholders.
This shift offers important opportunities:
- Expanded patient access
- Cost-effective care delivery
- Enhanced clinical workflow and capacity
- Stronger alignment with value-based care priorities
3. Phase-Out of the Inpatient-Only (IPO) List
CMS will eliminate the inpatient-only list over the next three years. As services transition away from the IPO list, they will be exempt from the two-midnight rule, giving providers more discretion to determine the most appropriate care setting.
This introduces greater clinical flexibility but also reinforces the need for:
- Updated pathways
- Strong documentation
- Alignment with utilization review processes
4. Payment Reductions for Stress Tests and Other Diagnostic APCs
CMS is restructuring the diagnostic test ambulatory payment classifications (APCs), resulting in several notable reimbursement reductions:
- Stress tests (93017) and other services under Level 2 Diagnostic Tests APC 5722 will decrease from $311.40 to $220.60.
For practices that rely heavily on outpatient diagnostic testing, this may require reevaluating cost structures and operational workflows.
5. Significant Cuts to Nuclear Medicine Radiopharmaceutical Payments
Despite advocacy from ACC and other stakeholders, CMS finalized substantial reductions in reimbursement for select nuclear medicine radiopharmaceutical services, including:
- Amyloid imaging (78803) under Level 2 Nuclear Medicine APC 5592 decreases from $1,305.48 to $554.73.
These cuts may impact the feasibility of offering advanced imaging in certain outpatient or community settings where margins are already tight.
What This Means for Cardiovascular Practices
Overall, the 2026 OPPS Final Rule reinforces a continued shift toward outpatient cardiovascular care, with CMS signaling its intent to expand ASC access, tighten cost alignment, and reshape reimbursement for diagnostics and imaging. For many programs, these changes may influence everything from procedural strategy to testing economics.
For both independent groups and hospital-affiliated programs, now is an important time to reevaluate site-of-service strategy, ASC development opportunities, diagnostic workflows, and the potential financial impacts of IPO list changes. These shifts also present an opportunity to reassess long-term growth plans and clinical operations as the outpatient landscape continues to evolve.
At Heart & Vascular Partners, we work closely with practices to translate regulatory changes into practical strategy by supporting sustainable growth, strong patient outcomes, and long-term financial resilience. If your organization is assessing the implications of the 2026 OPPS and ASC rule, our team is ready to help.
