ASC billing - General review

General Information

Ambulatory Surgical Centers (ASCs) specialize in providing surgery, pain management, and
certain diagnostic (e.g., colonoscopy) services in an outpatient setting. Overall, the services
provided can be generally called procedures. In simple terms ASC qualified procedures can be
considered procedures that are more intensive than that done in the average doctors office but
not so intensive as to require a hospital stay. The general coverage rules regarding the medical
necessity of a particular procedure for a particular patient are applicable to ASC services in the
same manner as all other covered services. To be paid under this provision, a facility must be
certified as meeting the requirements for an ASC and must enter into a written agreement with
the Centers for Medicare & Medicaid Services (CMS).

The list of covered procedures merely indicates procedures which are covered and paid for if
performed in the ASC setting. It does not require such procedures to be performed in such
settings. The choice of a location to operate is a professional judgment of the patient’s physician
based on the beneficiary’s individual clinical needs and preferences.