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How is the Payment for Ambulatory Surgical Centers that provide Non-ASCS Services?

A solitary payment is made to an ASC for facility services and procedures outfitted by the ASC in association with a covered surgical system. But do keep in mind that extra payment might be made to the ASC for covered or secured ancillary services, particularly brachytherapy sources, certain implantable with pass through status under the OPPS, corneal tissue acquiring, drugs and biological for which separate installment is permitted under the OPPS, and radiology services again for which separate payment procedure is permitted under the OPPS.

For covered ancillary services for which separate payment is made, but first these items and services must be given fundamental resources to be covered under surgical techniques, that is, instantly, recently, or immediately after the covered secured surgical process.

Procedures not considered as ASC payments

Billing for Ambulatory Surgical Center can be difficult in light of considering the payments for non ASC procedures carried out in ASCs.

Various items and services secured under Medicare might be furnished in an ASC, which are not viewed as ASC services, but the payment for those procedures does get exclude. These non-ASC services are covered and paid for under the appropriate procurements of Part B. What's more, the ASC might be a piece of a medicinal complex that incorporates different elements, for example, an autonomous research center, supplier of durable medical equipment or a doctor's facility, which are secured as discrete elements under Part B.

All in all, an item or service provided in a separate part of the complex is not considered an ASC service, except as defined above

Illustrations of items and procedure charges that are not ASC services:

Items or Services Not Included Who Receives Payment
Non-Implantable Prosthetic Devices DME supplier. A supplier of DME must have a DME supplier number from the NSC and a separate NPI.
Purchase or Rental of Non-Implantable Durable Medical Equipment (DME) to ASC Patients for Use in Their Homes DME supplier. A supplier of DME must have a DME supplier number from the National Supplier Clearinghouse (NSC) and a separate National Provider Identifier (NPI). An ASC may not simultaneously be a DME supplier.
Ambulance Services Certified ambulance supplier.
Services Furnished by Independent Laboratory Certified laboratory (ASC can receive laboratory certification and a Clinical Laboratory Improvement Amendments number).
Facility Services for Surgical Procedures Excluded From the ASC List Not covered by Medicare.
Leg, Arm, Back, and Neck Braces DME supplier
Artificial Legs, Arms, and Eyes DME Supplier


The patient coinsurance for ASC-covered surgical procedures and covered ancillary services is 20 percent of the Medicare ASC payment after the yearly Part B deductible is met. Section 4104 of the Affordable Care Act waives the coinsurance and deductible for certain preventive services paid under the ASC payment system and recommended by the United States (U.S.) Preventive Services Task Force with a grade of A or B. Thus, billing for ASC needs to be carefully carried out especially when there are non ASC services carried out.

Published By - Medical Billers and Coders
Published Date - Mar-29-2016 Back

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