Ambulatory Specialty Model
The data already exists.
ASM makes value-based accountability mandatory for certain specialists beginning January 2027. CMS will adjust up to 12% of your Part B revenue based on episode cost and quality performance—scored against peers in your specialty and region.
The episode data CMS will use is structurally the same as what's available through MIPS today. The preparation window is now.
February 2026: CMS has named 6,637 clinicians on the preliminary ASM participant list. Search below ↓
What is the Ambulatory Specialty Model (ASM)?
The Ambulatory Specialty Model (ASM) is not a new reporting requirement; it is a fundamental shift to episode-based accountability. CMS is moving away from aggregate MIPS scores to measure specialists on three specific pillars:
You are no longer compared to the general pool, but exclusively to peers within your clinical specialty.
Performance is determined by the total cost of care for defined clinical episodes.
At full maturity, the model shifts from voluntary participation to a mandatory 12% Part B revenue adjustment.
Am I in a mandatory area?
ASM applies to 235 randomly selected metro areas. CMS stratified by spending and episode volume, then selected roughly 25% for mandatory participation.
Am I on the preliminary participant list?
CMS has published the preliminary list of 6,637 clinicians identified for ASM participation beginning in 2027—2,610 in the Heart Failure cohort and 4,027 in Low Back Pain. Search by name, NPI, or organization below, or browse the full list by state.
Source: CMS CY2027 Preliminary ASM Participant List. This is a preliminary list based on available claims data. Final participant determinations will be published mid-2026. Inclusion on the preliminary list does not guarantee final participation, and absence does not confirm exclusion.
Not on the preliminary list? That doesn't mean you're clear.
If you practice in a mandatory geographic area, you may still appear on the final participant list—CMS updates determinations using more recent claims data. The geographic tool below shows the 235 mandatory areas. If you're on the preliminary list, plan as if you're in. If you're not on the list but are in a mandatory area, you should still prepare.
Specialty and volume determine participation.
CMS determines your specialty based on the code used most frequently on your Medicare Part B claims. You must treat at least 20 attributed episodes in the relevant condition to be included.
Cardiology
(Two Part B claims within 180 days from same clinician)
Spine & Pain Specialties
(ICD-10 diagnosis + confirming code within 60 days)
Volume is assessed using 2025 data for the 2027 performance year.
Real revenue at risk.
Unlike MIPS, where most practices cluster near the performance threshold, ASM is designed to create meaningful payment differentiation. CMS chose penalties—not bonuses—for improvement activities and interoperability specifically to ensure scores don't cluster.
| MIPS | ASM | |
|---|---|---|
| Benchmarked against | All MIPS clinicians | Specialty peers only |
| Performance threshold | Fixed target | No threshold—relative only |
| Maximum adjustment | ±9% | ±12% by 2031 |
The preparation window.
Twelve months of preparation beats twelve months of waiting.
The episode-based cost measures CMS will use for ASM scoring are structurally the same as what's available through MIPS today. Different cadence, same underlying methodology.
Understand your cost position
Your MIPS episode data shows which patients drive costs. The same cohorts will drive ASM performance.
Identify variation
Episode-level visibility reveals where costs diverge from peers—imaging, hospitalizations, post-acute care.
Build primary care relationships
ASM requires collaborative care arrangements. Start those conversations now.
Test your reporting infrastructure
The 75% completeness rule means gaps in data capture become zeros in scoring.
Built for programs like this.
VBCA was founded by operators working inside federal value-based care programs. When CMS announced ASM, we didn't need new infrastructure—we pointed existing tools at a new use case.
Episode Cost Analytics
We built cost analytics because we needed it ourselves. The platform surfaces CMS cost data, identifies which patients drive episode costs, and shows where you stand relative to peers.
Episode-level cost visibility. Standard.
Explore cost analyticsCardiology-Specific Measures
Our AVBC measures address gaps in existing measure sets:
- •Echocardiogram Stewardship: Appropriate use in CHF—targets utilization patterns ASM will penalize
- •Noninvasive Ischemic Imaging: Reduces unnecessary stress imaging in chronic coronary disease
- •SGLT2 Inhibitors in CKD: Evidence-based prescribing that reduces heart failure hospitalizations
Unified Program Tracking
MIPS, MVPs, and ASM draw from overlapping data. Load once, track everything. If you fall below ASM's episode threshold and revert to MIPS, you'll have visibility into both.
See the platformSee how your current data maps to ASM.
Whether you're in a mandatory area or preparing proactively, we can show you where you stand using data that already exists.
Talk to us about ASM readiness