The Service Line

CMS wants to strip cardiovascular procedures off Medicare’s inpatient-only list starting in 2028, and its 2027 outpatient payment rule proposes doubling down on ambulatory surgery centers right now. The Centers for Medicare and Medicaid Services (CMS) published its calendar year 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule on July 2, 2026, proposing to remove roughly 637 procedures, about half of what remains on the inpatient-only (IPO) list, and singling out the cardiovascular services family for removal in 2028 because of its clinical complexity. The same rule proposes adding 618 procedures to the ASC Covered Procedures List and reassigns several cardiac ambulatory payment classifications, including percutaneous coronary intervention with drug-eluting stents and cardiac PET/CT, while raising overall OPPS rates 2.4 percent. For a specialty already building cath and electrophysiology (EP) capacity in ASCs and office-based labs after catheter ablation’s 2026 addition to the covered procedures list, the IPO signal is the clearest marker yet of where CMS wants cardiac procedure volume to land and where per-case reimbursement is heading. Confidence: High on the proposal’s substance; Medium on the exact comment deadline, reported elsewhere as August 31, 2026. Sources: Calendar Year 2027 Hospital OPPS/ASC Proposed Rule fact sheet, CMS, CMS Releases 2027 Hospital OPPS and ASC Proposed Rule, American College of Cardiology.

Reimbursement

Every cardiologist who treats Medicare heart failure patients in an outpatient setting inside a selected region will be forced into two-sided financial risk starting January 1, 2027, whether they want it or not. CMS finalized its Ambulatory Specialty Model (ASM) as a mandatory five-year program running through December 31, 2031, requiring participation from cardiologists who commonly treat Original Medicare heart failure patients in outpatient settings within CMS-selected geographic regions, while excluding interventional cardiology, EP, advanced heart failure and transplant subspecialists from the mandate. CMS will score participants on cost, quality, improvement activities and interoperability over 12-month performance periods and apply payment adjustments of negative 9 percent to positive 9 percent on future Medicare Part B claims, a swing large enough to move a general cardiology group’s bottom line on its own. CMS released the selected regions and a preliminary participant list in early 2026, and the American College of Cardiology (ACC) is still pushing for changes ahead of launch. Confidence: High on the mandatory structure, payment range and dates; Medium on the final region and participant lists, which CMS can still revise before January 1. Sources: Ambulatory Specialty Model, CMS, ACC Urges Changes as Ambulatory Specialty Model Approaches 2027 Launch, MedAxiom.

Enforcement

A Phoenix-area cardiology group and three of its physicians paid 4.75 million dollars this spring after the government alleged they ran ineligible veins through the ablation billing code for five years. Tri-City Cardiology and cardiologists Jaskamal Kahlon, Joshua D. Cohen and M. Joshua Berkowitz agreed to a False Claims Act settlement, announced by the Department of Justice (DOJ), resolving allegations that between January 2017 and April 2022 they performed endovenous ablations on perforator veins that did not meet accepted medical criteria for treatment, and that staff recorded vein-diameter measurements supporting the procedures rather than what was actually measured. Of the settlement, 4,606,247.22 dollars goes to the federal government and 143,752.78 dollars to the state of Arizona; the practice and physicians admitted no liability and deny the allegations, as is standard in civil False Claims Act resolutions. The underlying theory, treating veins that do not meet ablation criteria, is the same pattern regulators have flagged nationally for vein ablation billing (CPT 36475/36478), making perforator and small-vein ablation rates one of the clearest audit triggers in the specialty. Confidence: High. Source: Arizona Cardiology Group to Pay $4.75M to Resolve Allegations of Unnecessary Vein Ablations, U.S. Department of Justice.

Who’s Buying

Nearly half of all private cardiology practices are now sitting inside a private equity portfolio, and the payers are starting to build their own value-based lanes into the same groups. MedAxiom’s Cardiovascular Provider Compensation and Production survey found that close to 50 percent of private-practice cardiology groups now have private equity ownership, up from effectively zero just a few years ago, though MedAxiom president and CEO Jerry Blackwell told the American College of Cardiology’s 2026 annual meeting he does not expect private equity to become the dominant ownership model long-term. Separately, Humana announced March 3, 2026 that it is expanding value-based cardiology partnerships for its Medicare Advantage members to four platforms, Cardiovascular Associates of America’s Novocardia Care Solutions division, Karoo Health, US Heart and Vascular and Chamber Cardio, giving participating cardiologists shared-savings arrangements built around proactive, evidence-based care instead of fee-for-service volume. For groups weighing a private equity recapitalization against staying independent, the read is that both the equity path and the payer-risk path into cardiology are now live at scale, and a group can end up on both at once. Confidence: Medium on the private equity ownership percentage, which is survey-based; High on the Humana partnership terms and date. Sources: Private Equity Firms Own Half of Cardiology Practices: MedAxiom Survey, TCTMD, Humana Introduces New Value-Based Cardiology Care Partnerships for Medicare Advantage Members, Humana.

Clinical Policy

CMS wants to scrap the procedure-volume thresholds that have governed which hospitals can offer TAVR for a decade, and operators have two days left to weigh in. CMS’s proposed decision memo for the Transcatheter Aortic Valve Replacement (TAVR) national coverage determination (NCD) would eliminate facility-level procedural volume requirements and replace them with infrastructure and capability standards instead, requiring hospitals to maintain on-site cardiac surgery, a structural heart program and critical care resources, while shifting from fixed operator case-count minimums toward outcomes-based quality oversight. The proposal also ends the Coverage with Evidence Development requirement for symptomatic severe aortic stenosis patients while extending that requirement to asymptomatic severe cases, and it would let TAVR heart teams complete a second required patient evaluation by telehealth or chart review instead of requiring two in-person visits. The public comment period on the proposed memo closes July 15, 2026, with CMS’s national coverage analysis expected to be final by September 13, 2026; hospitals and structural heart programs that have been unable to hit legacy volume minimums stand to gain the most if the change survives to the final decision. Confidence: High on the proposal’s substance; Medium on the exact comment close date, since CMS’s TAVR reconsideration docket has run multiple overlapping comment rounds. Sources: NCA - Transcatheter Aortic Valve Replacement (TAVR) (CAG-00430R2), CMS, CMS Proposes Updates to TAVR National Coverage Determination, American College of Cardiology.

The Operator Metric

The number to track this week: 112,475 dollars, the gap that just opened between what hospitals pay employed cardiologists and what private practice pays. MedAxiom’s Cardiovascular Provider Compensation and Production survey put 2024 median total compensation for hospital-integrated, full-time cardiologists above 700,000 dollars for the first time while private-practice cardiologists fell to a median of 588,479 dollars, the widest gap between the two employment models in more than five years, even as overall median cardiologist compensation hit an all-time high of 694,954 dollars. The same survey found patient panels climbing toward 2,000 per physician full-time-equivalent and new-patient office visits falling to 15.4 percent of total visits, the first drop in years, suggesting the compensation premium at hospitals is arriving alongside genuine access strain rather than simply better productivity. Any group benchmarking an employment offer, a private equity recapitalization or a retention counteroffer this week should run it against that six-figure gap, not last cycle’s numbers. Confidence: High; survey-based (MedAxiom, 2024 data, reported October 2025 and still the most current published figure). Sources: New Data on Cardiology Compensation and Production Highlights Solutions for Workforce Shortages, MedAxiom via Business Wire, Cardiologist compensation hits an all-time high, Cardiovascular Business.