Medicare To Implement The New Ambulatory Specialty Model For Beneficiaries With Heart Failure & Those With Low Back Pain

The Centers for Medicare & Medicaid Services (CMS) is finalizing the new Medicare Ambulatory Specialty Model (ASM), which will be mandatory in selected regions for specialists treating beneficiaries with Original Medicare for heart failure or low back pain in an outpatient setting. Heart failure and low back pain account for 3.5% and 2.7% of total Medicare Part A and B spending, respectively, according to estimates included in the final rule for the Physician Fee Schedule for 2026.

“This model rewards specialists who detect signs of worsening chronic conditions early, enhance patients’ function, reduce avoidable hospitalizations, and use technology . . .