The ASC opportunity in cardiac ablation after CMS approval

By Arnold Lee, MD and Lee Smith, Chief Evangelist at AcuityMD‍

The Centers for Medicare and Medicaid Services (CMS) has unlocked a big opportunity, allowing certain cardiac ablation procedures in ambulatory surgery centers (ASCs) for the first time.

MedTech companies have a chance to drive ASC ablation growth, but a narrow window exists to win in this highly competitive market. Companies that want to own this shift need to make the right move quickly.

Health systems are under pressure. ASCs are the release valve

Cardiac ablations are a triple threat, straining budgets, logistical operations, and personnel.

Rising procedure volume is amplifying this. Nearly 500,000 cardiac ablations were performed in 2024 -- an 11% increase since 2022, despite reduction in reimbursements for conditions like atrial fibrillation.¹‍

Medicare Advantage and Medicare Fee-For-Service (FFS) cover 72% of these procedures, but because they weren't previously approved for ASCs, 93% of ablations are still performed in hospitals. However, those reimbursements generally don’t meet ablation case expenses. A 2019 study showed an average cost of nearly $30,000 per procedure, and costs in general have only increased since.

According to AcuityMD’s most recent reimbursement data, average Medicare Advantage paid amounts range from $15,000 to $23,000, depending on procedure type.² The Medicare FFS range is much less, only $1,600 to $3,500.

Hospitals are bleeding money on these procedures, even before complications tip the scales. Nearly 15% of cardiac ablation patients for ventricular tachycardia (VT) are readmitted within 30 days, worsening the financial burden. Readmissions hurt not only patients but systems as well as CMS will turn these readmissions into fiscal penalties.

Economic and clinical upsides are driving health systems to steer lower-risk cardiac ablations toward the more economically efficient ASC ecosystem. Chief among these motivations is recouping the investments they’ve made in these facilities, as well as improving patient outcomes. On the regulatory front, relaxation of the Certificate-Of-Need regulations in states like Georgia and North Carolina have the potential to ease future roadblocks on a national level. But new and innovative technology cannot sell itself; administrators will need rock solid clinical and financial ROI data for buy-in.

Cardiac ablation - the wedge we've been waiting for?

Pulmonary vein isolation (PVI), one of the procedures approved for ASCs, is now the most common type of cardiac ablation, growing nearly 18% from 2022 to 2024. Analysts project new techniques such as pulsed field ablation will double the global cardiac ablation market to $10 billion in the next five years.

Pulsed field ablation is well-suited for ASCs because it requires shorter case times, less time under anesthesia, better recovery, which in turn leads to lower readmission rates. And there’s more: pulmonary vein isolation has the highest Medicare Advantage and Medicare FFS reimbursement rates of the cardiac ablation procedures approved for ASCs at $20,000.³

A go-to-market playbook for launching PVI in ASCs

The ASC opportunity landscape is not created equal, with trends varying widely across the nation. A solid go-to-market playbook to lead this shift must start with identifying the regions where the biggest opportunities are.

Significant volume and growth rate disparities for other procedures have plagued ASCs during the transition from hospitals, at both regional and state level.

AcuityMD’s best-in-class market data can position MedTech commercial teams capitalize on this trend to build multiple game-winning strategies.

Step 1: Identify geographies with the right market dynamics

First, identify the areas where interventional cardiologists have already started performing procedures at ASCs. This will reveal which geographies are already prepared for the shift, and likely to bring more procedures into the outpatient surgical setting.

Step 2: Refine your ICP and prioritize the right opportunities

Narrowing in on the ideal specialist e.g. cardiac electrophysiologists who are performing PVI, and also operating at ASCs is a logical market segment to start with. Converting this cohort will give MedTech commercial teams valuable field data to prove the clinical and financial impact of shifting these procedures to ASCs, such as increased volume, better patient outcomes, and improved economics.

From there, expanding your ICP to other specialists not yet performing PVI, or those yet to move to the ASC setting becomes more plausible. The supporting data, along with clinical champions, unlocks multiple avenues to convert more business (e.g., peer network targeting and education). 

Step 3: Drive market development efforts

As early adopters pave the way for this transition, other market development activities can help accelerate the benefits for manufacturers, surgeons, and patients. Through longitudinal patient data, market development managers can look upstream to identify which physicians are seeing and referring potential PVI patients. Educating those referring physicians on the benefits of the shift into ASCs, along with various patient education programs can both be very effective adjuncts to the core commercial efforts. 

Why first movers will lock In lasting advantage

This is a golden opportunity for MedTech companies to drive ASC ablation adoption and growth for PFA. The window is narrow, the competition stiff, and calculated yet speedy execution can win the day.

Companies that rely on instinct, anecdotal data, or existing relationships could make strategic missteps. The companies that move first with precision data will define this new market, build valuable partnerships, and secure key equipment purchases to create a presence that will be hard for the competition to displace.

Learn how companies are using AcuityMD to win in this space – request a demo today.

‍

Notes

¹ AcuityMD analysis of 2022 to 2024 claims data for the following procedures:

• AV node ablation
• Supraventricular tachycardia ablation or ablation of atrial focus
• Ventricular ablation for ventricular arrhythmias
• Pulmonary vein isolation ablation for atrial fibrillation 

² Paid amount is how much a facility received from a payer, separate from patient co-pays

³  Boston Scientific Corporation. FARAPULSE Coding and Payment Quick Reference Guide. 2025. EP-1784610-AH.