Physician Names Released for Required Ambulatory Specialty Model Participation

The Centers for Medicare and Medicaid Services (CMS) has released a searchable database of physicians who will be required to participate in new payment models for heart failure and lower back pain starting January 1, 2027. The models will run for five years.  

Please email ACOI at acoi@acoi.org and include “CMS ASM” in the subject line if you have been selected into the program. ACOI will work to provide selected ACOI members with information and resources. ACOI also wants to learn from selected ACOI members so it can effectively advocate with CMS for program changes.  

The Ambulatory Specialty Models (ASMs) build off the Merit-based Incentive Payment System (MIPS) Value Pathways and will measure provider performance in the areas of quality, care improvement, cost, and interoperability.

To be assigned to one of the two models, providers will have met the following criteria:

• Bill under the Medicare physician fee schedule;
• Practice in one of the targeted geographic areas;  
• Have a selected specialty type of general cardiology for the heart failure model;
• Have a selected specialty type of anesthesiology, pain management, interventional pain management, neurosurgery, orthopedic surgery, or physical medicine and rehabilitation for the low back pain model; and
• Have historically treated at least 20 heart failure or low back pain episodes per year as identified by the episode-based cost measure methodology.

CMS will use data from the calendar year two years before a given ASM performance year to evaluate these criteria. For example, CMS will use data from 2025 to determine final eligibility for the 2027 performance year.

Participants will have their Medicare Part B payments adjusted in the range of -9 percent to +9 percent in the first two payments years (2028 and 2029), and the range will increase in later payment years. The payment adjustment is at the individual clinician level and applies to all of a clinician’s Part B claims.  

Additional resources, including a FAQ, can be found here.  

CAPITOL ROUNDS FEBRUARY 2026