How many procedures does the CY 2027 proposed rule add to the ASC covered procedures list?

CMS proposed adding 618 procedures to the ASC covered procedures list in the CY 2027 OPPS/ASC proposed rule (CMS-1850-P), released July 2, 2026. The additions track the 637 services CMS proposed removing from the inpatient-only list in 2027, the second phase of eliminating that list, with the remaining services slated for 2028. CMS also proposed a 2.4% update to ASC payment rates for centers that meet quality reporting requirements. The final rule is usually published in early November and takes effect January 1.

Does a procedure on the ASC covered procedures list mean every patient is safe for a surgery center?

No. The covered procedures list decides where Medicare will pay for a procedure. It does not decide which patients belong in a surgery center. That is still the center's patient-selection policy and the anesthesia provider's judgment. Most ASCs accept patients up to ASA III, and a well-controlled ASA III patient can be done safely with the right plan. A patient with unstable cardiac disease, decompensated heart failure, or an anticoagulant that cannot be safely held belongs in a hospital, whatever the list says.

How should a surgery center update pre-op screening for higher-acuity procedures?

Review the anesthesia questions at scheduling instead of the morning of surgery. Update the patient-selection policy with the anesthesia medical director for any new procedure the center plans to add. Decide early which patients go to the hospital instead, so the case is never booked in the wrong building. Require the same pre-op review for every surgeon who operates at the center. Track same-day cancellations and transfers, and whether they happened before or after the procedure started.

CMS Wants 618 More Procedures in Surgery Centers for 2027. Is Your Pre-Op Screening Ready?

In July, CMS proposed adding 618 procedures to the list of surgeries Medicare will pay a surgery center to perform. The final rule usually lands in early November and takes effect January 1. The list is about to change. The bigger change is the patients who come with it.

What CMS proposed

The calendar year 2027 outpatient and ASC proposed rule (CMS-1850-P) came out on July 2, 2026. For surgery centers, three parts matter most:

618 procedures proposed for the ASC covered procedures list. They track the 637 services CMS proposed taking off the inpatient-only list in 2027.
The inpatient-only list keeps shrinking. 2026 was the first year of a three-year phase-out. 2027 is the second. The rest is slated for 2028.
A 2.4% proposed update to ASC payment rates for centers that meet quality reporting requirements.

There is one more item most people skipped. CMS asked for comment on splitting the ASC transfer and admission measure by phase of care: before the procedure, during it, or after it. If that moves forward, a patient sent to the hospital before the case even starts gets counted on its own line. A transfer that happens before the procedure is a screening problem, and it would become visible.

The list says where Medicare pays. It does not say who belongs.

This is the part I want every administrator and medical director to hear. When a procedure lands on the covered list, Medicare will pay a surgery center to do it. That is all it means. It does not mean every patient who needs that procedure is safe in your building.

Procedures that used to require an inpatient stay tend to bring a certain patient with them. Older. More medications. Atrial fibrillation on apixaban. Coronary stents. Sleep apnea. Kidney disease. Diabetes on an SGLT2 inhibitor. Heart failure that is controlled most of the time. None of those, alone, rule a patient out. Most surgery centers accept patients up to ASA III, and a well-controlled ASA III patient can be done safely with the right plan. ASA class is a description of the patient, not a reason to cancel.

But some of these patients belong in a hospital no matter what the list says. Unstable cardiac symptoms nobody has worked up. A drug-eluting stent still inside its required antiplatelet window. Heart failure that is not compensated. An anticoagulant that cannot be safely held for the anesthetic you plan to give. Those calls belong to your patient-selection policy and to the anesthesia provider, not to the payment rule.

Where screening breaks

I am a CRNA. I have been the person reading the chart for the first time at 6:50 a.m. When the anesthesia questions are asked that late, every problem they find becomes a same-day cancellation or a transfer. Higher-acuity cases make that worse in two ways. There are more findings per chart, and each finding needs more lead time to fix. A cardiology visit takes weeks. An anticoagulant hold has to be planned days ahead. A CPAP machine has to come with the patient.

Most centers already collect the right documents: the H&P, the medical clearance letter, labs, the EKG, the medication list. The gap is not paperwork. It is that nobody reads those documents with the anesthesia questions in mind until the morning of surgery. A medical clearance is not an anesthesia clearance. A signed letter from the primary care office says the patient is medically stable. It does not say the apixaban was held long enough for a spinal.

Five things to do before January 1

Decide which new procedures you will actually add. Pull the CMS additions file for your specialties when the final rule comes out. For each procedure you plan to bring in, sit down with your anesthesia medical director and write down which patients qualify and which go to the hospital.
Move the anesthesia review to the day the case is scheduled. Not the day before. The review has to happen while there is still time to fix what it finds.
Make the site decision early. If a patient belongs in a hospital, the right time to know is before the case is booked in your center, not after the patient arrives in a gown.
Require it for every surgeon. If only some surgeons send their patients through an early review, your cancellations simply come from the other rooms. Treat it like the H&P and the consent: required before the case is confirmed.
Track cancellations and transfers by phase. Whether or not CMS finalizes the change to the transfer measure, count how many of your same-day cancellations and transfers happened before the procedure started. That number is your screening gap.

Where VeriOp fits

VeriOp.ai reads the pre-op documents your center already collects and reviews them from the anesthesia perspective, the same lens the anesthesia provider applies on the morning of surgery, but weeks earlier. It shows the ASA class and why, the medication holds, and what still needs to happen before the patient can go ahead. It also flags when a patient's findings are beyond what a surgery center should take on, so the case moves to the hospital before it is booked in your building. Every case sits on one dashboard for the coordinator.

VeriOp does the reading. The clinician validates. A licensed anesthesia provider makes every final call. It runs in a browser and works without your EHR, with no IT project.

If you run a surgery center and want to see it on your own cases before the new list takes effect, start at www.veriop.ai/ambulatory.

Sources: CMS, Calendar Year 2027 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Proposed Rule (CMS-1850-P), fact sheet, July 2, 2026; Federal Register document 2026-13656, July 7, 2026. Figures are from the proposed rule and may change in the final rule.