SERVICES FURNISHED IN AN ASC WHICH ARE NOT ASC FACILITY SERVICES

A single payment is made to an ASC which includes all facility services furnished by the ASC in connection with a covered procedure. However, a number of items and services covered under Medicare may be furnished in an ASC which are not considered facility services, and which the ASC payment does not include. These non-ASC services are covered and paid for under the applicable provisions of Part B. In addition, the ASC may be part of a medical complex that includes other entities, such as an independent laboratory, supplier of durable medical equipment, or a physician’s office, which are covered as separate entities under Part B. In general, an item or service provided in a separate part of the complex is not considered an ASC service, except as defined above. Following is a chart as to who may receive payment and where to submit the bill.

Examples of payment and billing for items or services that are not ASC facility services for claims with dates of service prior to January 1, 2008.

Items NOT Included in the ASC Facility Rate	Who May Receive Payment	Submit Bills To:
Physicians’ services	Physician	A/B MAC
The purchase or rental of non- implantable durable medical equipment (DME) to ASC patients for use in their homes	Supplier        NOTE: An ASC can be a supplier of DME if it has a supplier number from the National Supplier Clearinghouse	DME MAC
Implantable DME and accessories	ASC	A/B MAC
Non-implantable prosthetic devices	Supplier	DME MAC
Implantable prosthetic devices except certain intraocular lenses (IOLs and NTIOLs), and accessories	ASC	A/B MAC
Ambulance services	Certified Ambulance supplier	A/B MAC
Leg, arm, back, and neck braces	Supplier	DME MAC
Artificial legs, arms, and eyes	Supplier	DME MAC
Services furnished by an independent laboratory	Certified lab. ASCs can receive lab certification and a CLIA number.	A/B MAC
Procedures NOT on the ASC list	Physician	Physician bills A/B MAC for procedure and any implantable prosthetics/DME. ASC bills beneficiary for facility charges associated with the non-covered procedure

Examples of payment and billing for items or services that are ASC facility services for claims with dates of service effective January 1, 2008.

Items Included in the ASC Facility Rate	Who May Receive Payment	Submit Bills To:
Implantable DME and accessories without OPPS pass-through status	ASC	A/B MAC
Implantable nonpass-through prosthetic devices (except NTIOLs) and accessories without OPPS pass-through status	ASC	A/B MAC
Drugs and biologicals for which there is no separate OPPS payment	ASC	A/B MAC