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.
What is the Ambulatory Specialty Model (ASM)?
ASM is designed to test whether linking specialist payments to performance on quality, cost, care coordination, and meaningful use of certified electronic health record technology (CEHRT) leads to more effective upstream management of chronic conditions. The model builds on the Merit-Based Incentive Payment System (MIPS), and its results could inform future refinements to MIPS.
The model will launch on January 1, 2027, with two cohorts: (1) Low Back Pain and (2) Heart Failure. CMS selected these chronic conditions because they account for a significant share of Medicare fee-for-service spending and have established episode-based cost measures.
Under the model, participants must report a defined set of measures and activities, and performance is assessed against peers within the same cohort. Future Medicare Part B payments will be adjusted based on ASM performance, with participants facing financial risk ranging from 9% to 12% depending on the payment year.
Importantly, ASM participants are exempt and not allowed to participate in MIPS during the ASM performance years in which they meet ASM eligibility criteria. However, ASM participants may remain in other CMS Innovation Center Models and accountable care organizations (ACOs), including the Medicare Shared Savings Program.