CMS Ambulatory Specialty Model: Mandatory Participation Locations Announced
- APMConnect
- Dec 30, 2025
- 2 min read
A New Era of Specialist‑Led Value‑Based Care
CMS has finalized the Ambulatory Specialty Model (ASM)—a mandatory, condition‑focused value‑based care initiative designed to transform specialist care for Original Medicare beneficiaries. Launching on January 1, 2027, and running through December 31, 2031, ASM targets outpatient specialists treating heart failure and low back pain, two of the most costly chronic conditions in Medicare. Unlike many prior voluntary models, ASM requires eligible specialists in selected regions to participate and take financial accountability for both quality and cost outcomes.
Participation in the ASM will be required for specialists who meet CMS eligibility criteria and practice in selected Core‑Based Statistical Areas (CBSAs). CMS released the list of mandatory participant regions, giving clinicians time to prepare for reporting, care coordination, and financial accountability requirements.
Mandatory Locations for ASM
CMS intends to implement the ASM in approximately one‑quarter of all metropolitan areas nationwide. Based on CBSA concentration, the following states are positioned to have the largest potential impact:
State | Number of CBSAs |
Texas (TX) | 17 |
Florida (FL) | 12 |
California (CA) | 12 |
New York (NY) | 11 |
Illinois (IL) | 11 |
Pennsylvania (PA) | 10 |
North Carolina (NC) | 9 |
Tennessee (TN) | 9 |
Michigan (MI) | 8 |
Wisconsin (WI) | 8 |
CBSA Locations for Mandatory ASM Participation
Preparing for ASM
Specialists identified for mandatory participation will need to begin preparing well in advance of the model’s 2027 start date. Key readiness areas include evaluating geographic and episode eligibility, strengthening care coordination with primary care providers, and building infrastructure for data reporting, quality measurement, and financial risk management.
The ASM signals a broader shift in CMS innovation strategy—placing specialists at the center of value‑based care transformation. Practices that proactively assess their readiness and align clinical, operational, and financial strategies will be best positioned to succeed under this new mandatory model.
Access the CMS ASM CBSA list by visiting the ASM CMS website.
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