Ambulatory Specialty Model · 2027
Up to 12% of Part B revenue, scored against your specialty peers.
Mandatory for named specialists beginning January 2027. The episode data CMS will use is already available through MIPS today. Check whether you are on the list, then prepare on that data.
What is the Ambulatory Specialty Model (ASM)?
The Ambulatory Specialty Model (ASM) replaces aggregate MIPS scores with episode-based accountability for the specialists it covers. CMS will measure participants on three pillars:
Specialty-specific peer groups
You are no longer compared to the general pool, but exclusively to peers within your clinical specialty.
Episode cost measurement
Performance is determined by the total cost of care for defined clinical episodes.
Mandatory revenue risk
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.
Absence from the preliminary list does not mean you're clear.
If you practice in a mandatory geographic area, you may still appear on the final participant list, because 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, but your area is mandatory, prepare anyway.
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. Selected clinicians will be exempt from MIPS during the model. Until then, standard MIPS eligibility rules still apply for 2026.
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.
Adjustments reach ±12% of Part B revenue.
Unlike MIPS, where most practices cluster near the performance threshold, ASM is designed to create meaningful payment differentiation. CMS chose penalties rather than bonuses for improvement activities and interoperability specifically so that scores spread apart.
| MIPS | ASM | |
|---|---|---|
| Benchmarked against | All MIPS clinicians | Specialty peers only |
| Performance threshold | Fixed target | No threshold; relative only |
| Maximum adjustment | ±9% | ±12% by 2031 |
From today to the 2029 payment adjustments.
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. The cadence differs, but the methodology underneath is the same.
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, and 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.
The platform we built for MIPS already does this work.
VBCA was founded by operators working inside federal value-based care programs. When CMS announced ASM, we pointed existing tools at a new use case rather than building new infrastructure.
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 comes standard.
Explore cost analytics →Cardiology-Specific Measures
Our AVBC measures address gaps in existing measure sets:
Echocardiogram Stewardship: Appropriate use in CHF, targeting 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 platform →See how your current data maps to ASM.
Send us your NPI. We'll check your cohort and mandatory-area status, then show you where your existing MIPS episode data says you stand.
Get an ASM readiness read