Explore the ASM
Disclaimer: CMS has proposed adjustments to the Ambulatory Specialty Model in the Medicare Physician Fee Schedule proposed rule. This page will be updated in November when CMS finalizes its ASM policies. Contents of these pages reflect current ASM policies as finalized in November 2025.
Overview of Payment Adjustments
Depending on performance, ASM participants will receive a positive, neutral, or negative payment adjustment during the payment year, which occurs two years after the performance year.
Incentive Pool Calculation
To calculate the available payment adjustment, CMS will establish virtual incentive pools based on participants’ actual Medicare Part B spending for covered professional services during the performance year.
These pools represent a fixed percentage of total Part B payments made to clinicians in each cohort and are used to calculate scaled payment adjustments that are redistributed to participants during the payment year.
To establish the incentive pools, CMS will first calculate total Medicare Part B payments for all covered professional services made to ASM participants by cohort in the performance year.
Application of Risk Levels
That amount is then multiplied by the applicable ASM risk level for the payment year:
- CY 2029 Payment Year / CY 2027 Performance Year: 9%
- CY 2030 Payment Year / CY 2028 Performance Year: 9%
- CY 2031 Payment Year / CY 2029 Performance Year: 10%
- CY 2032 Payment Year / CY 2030 Performance Year: 11%
- CY 2033 Payment Year / CY 2031 Performance Year: 12%
CMS will also apply an ASM Redistribution Percentage of 85%, which will set the pool of funding available for redistribution. The remaining 15% will be retained by Medicare as program savings.
Scoring and Distribution Methodology
To translate participants’ ASM final scores into a payment adjustment, CMS will use a logistic exchange function, which will identify the participant’s final payment adjustment relative to other participants in the cohort.
This approach differs from MIPS in two ways:
- ASM does not include a fixed performance threshold that participants must achieve in order to receive a neutral or positive adjustment. Instead, ASM relies on more of a tournament scoring model, where payment adjustments are dependent on whether a participant’s performance exceeds the majority of other ASM participants each year.
- ASM uses a different distribution function than MIPS.
The magnitude of the payment adjustments will largely depend on the size of each ASM incentive pool and the distribution of final scores within each cohort.
Final Payment Application
The final payment adjustment factor will then be used to calculate a payment multiplier, which will be applied to all Medicare Part B payments for each participant’s covered professional services during the payment year—not just those payments applicable to low back pain.