A Structural Shift in Outpatient Orthopedics – and the Role of Diagnostics
Beginning January 1, 2026, a fundamental shift will take place in outpatient orthopedic care. The Centers for Medicare & Medicaid Services (CMS) has finalized a rule expanding Ambulatory Surgical Center (ASC) eligibility to include select revision total knee and hip arthroplasty procedures. This decision moves some of the most complex orthopedic cases into outpatient settings for appropriately selected patients.
While this policy change expands access and efficiency, it also raises the bar for diagnostic certainty. Revision arthroplasty carries inherently higher clinical risk-particularly related to occult infection-and the ASC environment allows far less tolerance for diagnostic ambiguity than traditional inpatient settings.
As outpatient orthopedics evolves, accurate, rapid infection diagnostics will become a foundational requirement for success. MicroGenDX, with more than a decade of published research and over a million samples processed, is already supporting orthopedic teams with molecular diagnostics designed for complex revision workflows.
What CMS Approved – and Why It Matters for ASCs
Effective January 1, 2026, Medicare and Medicaid beneficiaries will be eligible to undergo the following revision procedures in the ASC setting:
- 27488 – Removal of total knee prosthesis, with or without spacer
- 27487 – Revision total knee arthroplasty (femoral and entire tibial component)
- 27486 – Revision total knee arthroplasty (one component)
- 27134 – Revision total hip arthroplasty (both components)
- 27137 – Revision total hip arthroplasty (acetabular component only)
- 27138 – Revision total hip arthroplasty (femoral component only)
This expansion reflects a growing evidence base supporting safe, efficient outpatient revision care for carefully selected patients. For ASCs, it represents an opportunity to expand case mix, improve scheduling flexibility, and deliver high-value orthopedic care in a cost-efficient setting.
However, revision procedures introduce greater diagnostic complexity– particularly around periprosthetic joint infection (PJI). As these cases move outpatient, ASCs must be prepared to manage infection risk with precision, speed, and confidence.
The Diagnostic Reality of Revision Arthroplasty
Periprosthetic joint infection remains one of the most challenging complications in orthopedics. Numerous studies have demonstrated that 30–40% of PJIs are culture-negative, meaning traditional culture methods fail to identify the causative organism.
These are not low-risk cases. Culture-negative PJI has been associated with treatment failure rates approaching or exceeding 30%, leading to repeat surgeries, prolonged antibiotic courses, and poor functional outcomes.
In inpatient settings, prolonged hospitalization can partially compensate for diagnostic delays. In ASCs, however, decisions must be made quickly, often before or immediately after surgery. Without accurate organism identification, surgeons are forced to rely on empiric treatment strategies that may compromise outcomes.
This is where advanced molecular diagnostics become clinically essential rather than optional.
Why Diagnostic Accuracy Becomes Even More Critical in ASCs
The ASC environment compresses clinical timelines. There is limited tolerance for delayed results, inconclusive findings, or diagnostic uncertainty. For revision arthroplasty, this means:
- Identifying infection before revision whenever possible
- Detecting biofilm-associated and low-grade organisms
- Differentiating aseptic failure from occult infection
- Supporting targeted antimicrobial therapy rather than broad empiricism
Traditional culture-based testing struggles to meet these demands. Molecular diagnostics, by contrast, detect bacterial and fungal DNA directly from clinical specimens-identifying organisms that do not grow in culture, including slow-growing, fastidious, and polymicrobial pathogens commonly implicated in revision failures.
MicroGenDX’s combined qPCR + Next-Generation Sequencing (NGS) platform was designed specifically for these complex infection scenarios, with results available in as little as 24 from sample receipt to support outpatient decision-making.
Integrating Molecular Diagnostics into ASC Revision Workflows
As ASCs prepare for the CMS 2026 expansion, diagnostic workflows must align with outpatient realities, both clinically and operationally.
MicroGenDX supports ASCs by offering:
- Rapid PCR + NGS results to support perioperative decisions
- Detection of bacteria and fungi regularly missed by culture
- Identification of polymicrobial and biofilm-associated infections
- Predictable, transparent pricing aligned with ASC economics
- Flexible billing pathways, including direct insurance billing for outpatient cases
Importantly, molecular diagnostics can be integrated seamlessly into existing workflows. Specimens can be collected intraoperatively or during preoperative evaluation using standard techniques familiar to OR teams. Results are reported in a clinically actionable format designed to support surgical and antimicrobial decision-making.
For ASCs assuming responsibility for higher-acuity orthopedic cases, this level of diagnostic support helps protect outcomes while preserving efficiency.
A Broader Shift Toward Value-Based Orthopedic Care
CMS’s decision reflects a broader shift toward value-based, site-of-care optimization in orthopedics. By enabling revision arthroplasty in ASCs, CMS is reinforcing a model that prioritizes patient experience, cost stewardship, and operational efficiency.
However, value-based care depends on getting the diagnosis right the first time. Failed revisions, repeat surgeries, and prolonged antimicrobial therapy quickly erode the efficiencies ASCs aim to achieve.
Accurate infection diagnostics play a central role in safeguarding the success of outpatient revision programs-supporting better surgical planning, improved antibiotic stewardship, and reduced risk of failure.
Implementing the CMS Expansion – The Time is Now
The CMS rule expanding ASC eligibility for revision total knee and hip arthroplasty took effect on January 1, 2026. ASCs are now able to offer these procedures to Medicare and Medicaid beneficiaries- and many are already moving forward with implementation.
For ASCs beginning to offer or expand revision arthroplasty programs, critical operational elements must be in place:
- Infection diagnostic pathways
- Turnaround time requirements
- Staff education and specimen handling
- Billing and requisition workflows
- Diagnostic partners aligned with outpatient care
MicroGenDX is already working with ASCs and orthopedic teams nationwide to support this transition through research-backed molecular diagnostics, workflow guidance, and clinical support.
Looking Ahead: How MicroGenDX Helps ASCs Succeed Under the CMS Expansion
Outpatient revision arthroplasty is no longer a future concept-it is now CMS policy. As ASCs take on a larger role in complex orthopedic care, the ability to deliver safe, efficient, and evidence-based revision surgery will define success.
MicroGenDX helps ASCs meet this challenge by providing:
- Rapid, high-sensitivity PCR + NGS diagnostics
- Reliable detection of organisms missed by culture
- Support for complex, biofilm-associated infections
- Outpatient-friendly billing and operational workflows
- A proven clinical evidence base in orthopedic infection
By reducing diagnostic uncertainty and supporting confident decision-making, MicroGenDX enables ASCs to adopt revision arthroplasty procedures with greater assurance-protecting patient outcomes while preserving the efficiencies that make outpatient care valuable.
As January 2026 approaches, ASCs that prepare now-by strengthening diagnostic infrastructure alongside surgical capability-will be best positioned to lead the next phase of outpatient orthopedics. MicroGenDX is ready to support that transition.
