ASA Opposes Flawed and Adverse Payment Proposals from CMS for 2026

Today, ASA submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the CY 2026 Medicare Physician Fee Schedule proposed rule. Most important, ASA urged CMS to reconsider its opaque and potentially erroneous 2% payment cut to the anesthesia conversion factor for practice expense and malpractice adjustment. 

ASA’s wide-ranging letter opposed several other payment policies that would increase the financial strain on anesthesia group practices and provided detailed feedback on quality regulations:

• ASA cautioned CMS against shifting indirect practice expense payments from the facility to the nonfacility setting, citing the potential for further healthcare consolidation. 
• ASA opposed CMS’ proposed efficiency adjustment which operates under the unsupported assumption that physicians require less time to perform a procedure as it becomes more common. ASA argued that this policy could lead non-clinical stakeholders like facility executives to pressure anesthesiologists and other medical professionals to expedite care regardless of patient needs or acuity.
• ASA requested that CMS correct the utilization estimation of G2211 code and release the more than $1 billion in Medicare funding withheld as a result of this error.
• ASA supported the proposed incorporation of Percutaneous Image-Guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis codes.

Anesthesiologists and their groups may be significantly affected if CMS finalizes its Ambulatory Specialty Model (ASM) which is proposed in this rule. On that model, ASA expressed concern that nearly all anesthesiologists would be consigned to negative payment adjustments. ASA opposed the ASM low back pain cohort, especially the model’s mandatory status, and recommended that CMS consider how future models could be more applicable to specialties like anesthesiology.

On the Quality Payment Program, ASA reiterated a number of prior policy stances, supporting the decision to maintain the Merit-based Incentive Payment System (MIPS) performance threshold at 75 points and urging CMS against removing topped out measures that reflect a critical and central focus point of a specialty. ASA also opposed the removal of MIPS CQM 424: Perioperative Temperature Management from the traditional MIPS program as well as in the Patient Safety and Support of Positive Experiences with Anesthesia MVP.

Final regulations will be issued on or around November 1, and unless otherwise noted, policies will be effective January 1, 2026.

Please contact the ASA Department of Quality and Regulatory Affairs at qra@asahq.org with any further questions.

More resources:

• ASA Washington Alert on CY 2026 proposed rule
• Proposed rule (PDF)
• CMS press release on proposed rule
• QPP fact sheet