CMS released its 2027 proposed payment rule for outpatient hospital departments and ASCs on July 2, 2026, projecting reimbursement cuts for four of the most common spine pain management procedures in ASCs.
According to ASCA, proposed 2027 rates for top-volume pain management codes compared with 2026 final rates would be:
- Transforaminal epidural steroid injection (CPT 64483): $485.51 to $466.96, a decrease of $18.55
- Paravertebral facet joint injection, lumbar/sacral (CPT 64493): $485.51 to $466.96, a decrease of $18.55
- Facet joint destruction, lumbar/sacral, radiofrequency ablation (CPT 64635): $948.66 to $908.27, a decrease of $40.39
- Interlaminar epidural injection, lumbar/sacral (CPT 62323): $387.46 to $372.75, a decrease of $14.71
The cuts come despite an average 2.4% effective payment update across all ASC-covered procedures, driven by a 3.2% hospital market basket inflation adjustment offset by a 0.8-percentage-point productivity reduction under the ACA. CMS proposes an ASC conversion factor of $57.766 and an HOPD conversion factor of $102.004 for 2027, keeping the two payment systems aligned on the same update factor for an additional year.
Beyond pain management rates, CMS proposed several other changes relevant to spine and pain practices:
- CMS proposed adding 618 codes, expanding the range of procedures Medicare will pay for in the ASC setting.
- CMS proposed removing 637 procedures from the IPO list, continuing its multiyear phaseout.
- CMS proposed dropping measure ASC-9 (appropriate follow-up interval for normal colonoscopy in average-risk patients) and did not propose any new quality measures.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
