Medicare Covered ASC procedures (Ambulatory Surgical Centers)


Medicare Covered ASC procedures are those surgical services that are recognized by CMS on a posting that is upgraded on a yearly basis. Physician billing companies and surgical billing with some surgical procedures covered by Medicare are not on the ASC list of secured surgical methodology. For surgical procedures that are not Medicare Covered ASC procedures, the related proficient administrations might be charged by the rendering supplier as Part B services, and the recipient is obligated for the facility charges, which are non-covered/secured by Medicare.

  • Under the ASC payment framework, Medicare makes facility payments to ASCs just for the particular ASC secured surgical procedure on the ASC list of covered secured surgical techniques.

Likewise, Medicare makes separate payments to ASCs for certain covered ancillary services that are given vital to a secured ASC procedure.

All other non-ASC supervisions, for example, doctor services and prosthetic devices might be secured and independently billable under different procurement of Medicare Part B.

  • The Medicare meaning of secured or covered ASC facility services for a covered surgical procedure incorporates services that would be covered if furnished on an inpatient or outpatient premise regarding a covered secured surgical procedure. This includes operational and recuperation rooms, waiting rooms, and different regions utilized by the patient or offered for use to patients requiring surgical procedures.
  •  Ambulatory Medicaid Billing also incorporates all services and procedures given in association with covered surgical methods furnished by medical attendants, specialized staff, and others included in patient care. These do exclude doctor fees or restorative and other health services for which payment might be made under other Medicare procurements (e.g., services of an autonomous research facility situated on the same site as the ASC, anesthetist proficient services, non-implantable DME).

ASC procedures for which payment is incorporated into the ASC installment for a covered surgical procedure included, but not yet restricted are:

Included office administrations:

(1) Nursing, professional, and technician-related services.

(2) Use of the facility where the surgical procedures are performed.

(3) Any research center testing performed under a Clinical Laboratory Improvements Amendments of 1988 (CLIA) certification of waiver.

(4) Drugs and biological for which separate payment is not permitted under the hospital outpatient prospective payment system (OPPS).

(5) Materials, including supplies and equipment for the administration and monitoring of anesthesia.

(6) Supervision of the services of an anesthetist by the operating surgeon.

(7) Equipment;

(8) Surgical dressings;

(9) Implanted prosthetic devices, including intraocular lenses (IOLs), and related supplies.

(10) Implanted DME and related accessories and supplies and Splints, castes, and related devices.