Mandatory reporting for ASC-21 begins with calendar year (CY) 2028 procedures, but ambulatory surgery centers (ASCs) will start collecting data months earlier. For a patient scheduled for hip or knee replacement in January 2028, pre-op data collection can begin as early as Oct. 3, 2027.
ASC-21 is a patient-reported outcome-based performance measure (PRO-PM) in the Centers for Medicare & Medicaid Services (CMS) Ambulatory Surgical Center Quality Reporting (ASCQR) Program. It applies to total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed in ASCs.
What ASC-21 Measures
ASC-21 captures the proportion of patients undergoing primary elective THA or TKA whose self-reported joint function improves a meaningful amount between pre-op and approximately one year post-op. The measure applies only to Medicare fee-for-service (FFS) patients age 65 and older. Medicare Advantage patients are not included.
Each patient completes a joint-specific survey twice: within 90 days before surgery and again 300-425 days after. The pre-op collection also includes mental health, pain, health literacy and other risk variables CMS uses for risk adjustment.
Key Dates
- CY 2026-2027: Voluntary reporting, with no payment reduction for nonsubmission
- 3, 2027: Pre-op data collection begins for patients scheduled in January 2028
- CY 2028: Mandatory reporting begins
- CY 2031: Payment penalties first apply
The 45% Threshold
ASCs must reach 45% matched-pair completion. A matched pair is a patient who completed both the pre-op and post-op surveys. A pre-op or post-op survey alone does not count.
Centers that miss the threshold take a 2.0 percentage point reduction to their Medicare annual payment update. The reduction applies to every Medicare FFS procedure billed for the full year.
Plan Now for the Post-Op Gap
The post-op survey is the hardest part of ASC-21 to execute. It is collected 300-425 days after surgery, long after the patient’s last contact with the ASC. Patients are often confused by follow-up from the ASC nearly a year later, and compliance is low.
Since only matched pairs count toward the 45% threshold, a pre-op survey without a matching post-op survey does not help a center meet the requirement. The voluntary reporting period gives centers time to build and test a follow-up process before mandatory reporting begins.
Questions to Answer Now
- How many of your THA/TKA patients are Medicare FFS beneficiaries age 65 and older?
- When and where will patients complete the pre-op survey?
- How will you reach patients 300-425 days after surgery?
- Who will compile the data and submit it to CMS?
Learn More
CMS publishes the measure’s data submission template, required data elements and eligibility flowchart on QualityNet. The Quality Reporting Center offers ASCQR Program information, events and reporting resources.
- QualityNet PRO-PM resources: cms.gov/asc/measures/PRO-PM/resources
- Quality Reporting Center ASCQR Program: https://www.qualityreportingcenter.com/en/ascqr-program/
ASC-21 Readiness Guide for Members
ASCQC members: You have access to ASCQC’s “ASC-21 Readiness Guide,” developed with contributions from Ashley Bennett, Quality Director at OrthoSouth Surgery Centers. The guide covers eligibility criteria, a data collection reference chart, workflow options, post-op follow-up strategies, lessons learned from early adopters and a readiness checklist. If you have not received your copy of this resource, contact us.