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Three Stark Law thresholds changed on January 1, 2026: 

  • The nonmonetary compensation limit  
  • The annual limited remuneration threshold 
  • The medical staff incidental benefit per-occurrence limit 

The changes are already in effect and directly impact ASC physician-owners. And if you have not checked your year-to-date numbers yet, now is the time. 

The ASCA Annual Conference is just around the corner. Before you go, you need to know where each physician stands. 

This guide breaks down the 2026 Stark Law limits, the most common compliance traps, and the audit steps ASC teams should complete inside their ASC practice management software before ASCA.

TL; DR:  

  • The 2026 limited remuneration exception is $6,237 annually. 
  • ASCA registration fees, meals, hotel, and conference-related expenses may count toward the $535 cap.  
  • The return remedy is permitted only if:   
  • the excess is within 50% of the cap, and  
  • the physician has not used the remedy within the past 3 years. 
  • Before ASCA, every ASC should:  
  • calculate physician-level YTD totals,  
  • review conference reimbursements,  
  • and verify documentation for fair market value and commercial reasonableness 

What Is the Stark Law, and Why ASCs Need to Care

The Stark Law is a federal law. It controls how physicians refer patients. 

In many cases, a physician cannot send Medicare or Medicaid patients to a healthcare business they have a financial tie with. 

The law is strict. Intent does not matter. Even small mistakes can cause problems. 

For ASCs, Stark Law issues often involve: 

  • Physician ownership  
  • Consulting payments  
  • Medical director fees  
  • Travel or meal reimbursements  
  • Office or equipment leases  

Stark Law may apply to services like: 

  • Imaging  
  • Lab tests  
  • Physical therapy  
  • Medical equipment  

Common problems include: 

  • Payments linked to referrals  
  • Missing contracts  
  • Poor records  

Violations can lead to fines, repayments, and audits.  

ASCs are generally not considered designated health service (DHS) entities for the surgical procedures they perform. However, Stark Law can still apply when physician compensation arrangements or referral relationships involve DHS payable by Medicare.

Stark Law is generally considered a strict liability law. That means intent does not matter. If a threshold is crossed, it may still be a Stark Law violation.

Three key numbers update every year. Both changed on January 1, 2026.

The Three Stark Law Limits That Matter in 2026

Number 1: Non-Monetary Compensation Cap – $535 

Your ASC can give non-cash items to physicians. But there is a limit. 

In 2026, that limit is $535 per physician per year. 

That is an annual aggregate cap. Every qualifying item you give to one physician adds up. Once you hit $535, additional non-monetary compensation may create compliance risk. 

This cap covers things like: 

  • Conference registration fees (including ASCA) 
  • Meals tied to educational or business meetings 
  • Sporting event tickets 
  • Clinical education materials 

Cash and gift cards do not qualify under this exception at all. Even very small amounts are still excluded. A $20 gift card is not covered. A prepaid card is not covered. This exception is for non-cash, non-cash-equivalent items only. 

Number 2: Limited Remuneration Exception – $6,237 

This exception is different. It allows cash payments to physicians, up to $6,237 per year in 2026. 

That is up from $6,055 in 2025. The limit is updated annually to account for inflation. 

This exception is more flexible. It does not require a written agreement, a signature, or that amounts be set in advance. 

But four conditions still apply: 

  1. The compensation must be for items or services actually provided by the physician 
  1. It cannot be determined in any manner that takes into account the volume or value of referrals  
  1. The compensation must reflect fair market value  
  1. The arrangement must be commercially reasonable 

Like the first cap, this one also applies on an aggregate basis. All qualifying payments to a single physician add up across the full calendar year. 

Important: many ASC physician compensation arrangements are structured under other Stark Law exceptions, including the personal services exception, fair market value exception, and bona fide employment exception. The $6,237 limit applies specifically to the limited remuneration exception. 

Number 3: Medical Staff Incidental Benefits Limit – $46 Per Occurrence 

This rule covers small benefits given to medical staff members. 

In 2026, the limit is $46 per occurrence. That means each individual benefit must stay below $46. 

This is different from the $535 non-monetary compensation cap, which is tracked over the full calendar year. The $46 limit applies one occurrence at a time. It does not add up across the year. 

Examples may include: 

  • Coffee or snacks in the physician lounge  
  • Parking on facility property  
  • Low-cost meals provided during meetings  

These benefits must be modest and tied to normal medical staff activities. They also cannot be connected to the volume or value of physician referrals. 

This exception is most relevant for hospitals and facilities with a formal medical staff structure. 

The Traps, Where ASCs Get into Trouble

Knowing the numbers is step one. Understanding the traps is step two. 

Here are the four most common mistakes ASC administrators make. 

Trap 1: Treating the Cap as Per-Item Instead of Annual 

The $535 cap is not per event. It is not per quarter. It is the total for the full year, January 1 through December 31, 2026. 

A $250 ASCA registration fee and a $200 sponsored dinner already puts a physician at $450 for the year. Add one lunch meeting at $90 and the cap is crossed. 

Small items add up fast. Track them all year, not just in December. 

In many ASCs, these expenses are spread across operations, finance, physician relations, marketing, and conference coordination. That fragmentation is exactly why the aggregate cap gets missed. 

Without centralized practice management software, it becomes difficult to track Stark Law exposure across departments in real time. 

Operations may approve conference registration, finance may reimburse travel or meals, and physician relations may coordinate hosted events, but nobody is tracking the physician’s total Stark Law exposure in one centralized workflow. 

Trap 2: Not Knowing the 50% Overage Rule 

If you go over the $535 cap by accident, there is a correction option. But the exception is subject to strict conditions.  

The excess must be no more than 50% of the cap, meaning no more than $267.50 over the limit. 

If you exceed the cap more than that, the remedy does not apply. 

If you are within that range, the physician must return the excess value. The repayment must be completed by whichever occurs first: 

  • December 31, 2026, or 
  • 180 consecutive days from the date the excess was received 

Miss that window and the compensation may be treated as a prohibited referral arrangement. 

Trap 3: The One-Time-in-Three-Years Rule 

This is the trap that surprises even experienced compliance officers. 

The return option described above can only be used once every three years per physician. 

If you used it for a physician in 2024 or 2025, you cannot use it again in 2026 for that same physician. 

That means if you go over the cap this year, and the three-year window is already used, you have no correction path available. 

What If the Return Remedy Is Unavailable? 

If the physician exceeds the cap and the overage correction option is unavailable, ASC administrators should consult healthcare counsel regarding the CMS Self-Referral Disclosure Protocol (SRDP). 

The SRDP allows providers to voluntarily disclose actual or potential Stark Law violations to CMS and may help reduce financial exposure. 

Trap 4: The Often-Missed $46 Medical Staff Threshold  

This one applies specifically to hospitals and facilities with formal medical staff. 

Incidental benefits, small perks provided to medical staff, must stay below $46 per occurrence. 

Note that this limit is per occurrence, not annual aggregate. It works differently than the $535 cap. 

If you operate a facility with a formal medical staff structure, check both limits. 

What Counts Toward the $535 Cap

Many ASC administrators undercount. They track big-ticket items but miss smaller ones. 

Here is a practical list of what counts: 

  • ASCA conference registration paid or reimbursed by the ASC 
  • Hotel, meals, or travel tied to an educational event 
  • CME-related meals or refreshments 
  • Sporting event tickets 
  • Branded clinical education materials 
  • Books or reference guides provided to physicians 

Here is what does NOT qualify under the non-monetary compensation exception: 

  • Cash payments or cash equivalents  
  • Gift cards or prepaid cards  
  • Items the physician specifically requested, or requested by staff or employees acting on the physician’s behalf (solicited compensation does not qualify under this exception) 

Some cash payments may instead qualify under other Stark Law exceptions, including the limited remuneration exception, if all applicable requirements are met. 

One more thing: the compensation cannot be tied to the volume or value of a physician’s referrals. If it is, it does not qualify, regardless of the dollar amount. 

Your YTD Audit Checklist Before ASCA

Run through these seven steps before the conference. 

Step 1: List every non-monetary item given to each physician in 2026 YTD. 

Start from January 1. Pull data from your practice management software, including meals, registrations, tickets, and materials. 

Step 2: Total the aggregate per physician. 

Each physician has their own individual $535 cap. Do not combine or average across physicians. Keep each total separate. 

Step 3: Flag anyone at or above $400 YTD. 

Why $400? Because even partial conference reimbursements can quickly push a physician over the $535 annual cap.  

For example, if a physician is already at $400 YTD and the ASC later reimburses $150 in conference-related expenses, that physician would reach $550 and exceed the limit. Flagging physicians early gives ASC teams time to review planned conference spending before additional expenses are approved. 

Only the amount reimbursed or paid by the ASC counts toward the Stark Law limit, not the physician’s total out-of-pocket conference cost. 

Step 4: Check whether any physician is over the cap right now. 

If a physician is already over $535 YTD, determine the amount of the overage. Is it within the 50% threshold (i.e., $267.50 or less)? If yes, the return option may apply, but only if the three-year window is open for that physician. 

Step 5: Review your limited remuneration payments. 

List every cash payment made to physicians in 2026 not covered by another Stark exception. Total them per physician. The annual ceiling is $6,237. Check fair market value documentation for each payment. 

Step 6: Check the three-year remedy history. 

For any physician who is at risk of exceeding the cap in 2026, confirm whether they used the overage return remedy in 2024 or 2025. If yes, the remedy is unavailable until 2027 at the earliest. 

Step 7: Document everything. 

Even if you are within every threshold, keep clear records. Document what was provided, to whom, the fair market value, and the date. Strong documentation is your first line of defense in any audit.

Why You Need to Do This Before ASCA, Not After

The ASCA Annual Conference can get expensive fast. 

Registration fees, meals, travel, and networking events may all count toward the $535 Stark Law cap. 

Many ASC teams run into the same problem: conference spending is spread across different departments. 

Operations may approve registration. Finance may reimburse travel. Physician relations may cover meals. Nobody sees the physician’s full Stark Law total in one place. 

That creates compliance risk. 

This is where ASC practice management software helps. A strong system can: 

  • track physician-level expenses, 
  • monitor annual Stark Law thresholds, 
  • centralize reimbursements and approvals, 
  • and maintain documentation for audits. 

Before ASCA, ASC administrators should review physician totals early, not after expenses are approved. That gives teams time to adjust spending, document fair market value, and avoid compliance surprises later in the year.

A Quick Reference: 2026 Stark Law Numbers at a Glance

Exception 2026 Limit Cash Allowed? Written Agreement Required?
Non-Monetary Compensation $535/physician/year No No
Limited Remuneration $6,237/physician/year Yes No
Medical Staff Incidental Benefits $46/occurrence No No

What Happens If You Do Nothing

Stark Law violations are not intent-based. The threshold is either exceeded or it is not. 

If the $535 cap is exceeded without a valid correction, the relationship becomes a prohibited referral arrangement.  

Stark Law violations can trigger denial of payment, repayment liability, and, for knowing violations, civil monetary penalties up to $31,670 per prohibited service. 

This is not a gray area. CMS enforces this. CMS and OIG continue to scrutinize physician financial relationships and referral arrangements. 

Stark Compliance Does Not Automatically Mean AKS Compliance

Stark Law and the Anti-Kickback Statute (AKS) are separate laws. A compensation arrangement may satisfy a Stark Law exception but still create AKS risk if one purpose of the arrangement is to induce or reward referrals. 

This matters for conference spending, meals, entertainment, and physician-owner relationships. 

Physician-owned ASCs should also evaluate whether their ownership structure satisfies the ASC safe harbor under the Anti-Kickback Statute. 

Stark compliance alone does not eliminate AKS exposure. 

The Bottom Line

Three things matter for ASC Stark Law compliance in 2026. 

First: Know the thresholds. The 2026 limits are $535 for non-monetary compensation, $6,237 for limited remuneration, and $46 per occurrence for medical staff incidental benefits. 

Second: Understand the compliance rules. Stark Law limits are applied on an aggregate basis, and the overage correction option is both limited and time-restricted. 

Third: Review physician-level activity before approving additional conference or reimbursement expenses. 

ASC teams should audit year-to-date physician compensation, confirm fair market value documentation, and verify whether any prior overage remedies were used within the past three years. 

Practice management software should give ASC leaders a clear, physician-level view of compensation activity and compliance documentation in one place. 

CERTIFY Health helps physician-owned ASCs monitor financial activity and maintain audit readiness throughout the year. 

Note: Some states impose physician self-referral laws that are broader than federal Stark Law requirements. ASC administrators should confirm compliance with both federal and applicable state laws.