ASC payment - List of services inclusive with ASC

ASC SERVICES INCLUDED ON ASC LIST

The ASC payment rate includes only the specifically identified ASC services, included on the
ASC payment list. All other non-ASC services such as physician services, prosthetic devices, etc.
may be covered and separately billable under Medicare Part B. The Medicare definition of covered facility services for a covered surgical procedure includes services that would be covered if furnished on an inpatient or outpatient basis in connection with a covered surgical procedure.

This includes operating and recovery rooms, patient preparation areas, waiting rooms, and other
areas used by the patient or offered for use to patient’s needing surgical procedures. It includes
all services and procedures provided in connection with covered surgical procedures furnished
by nurses, technical personnel and others involved in patient’s care. These do not include
physician services, or medical and other health services for which payment may be made under
other Medicare provisions (e.g., services of an independent laboratory located on the same site as
the ASC, prosthetic devices other than intra-ocular lenses (IOLs), anesthetist’s professional
services, and non-implantable durable medical equipment (DME).

ASC services for which payment is included in the ASC payment for a covered surgical
procedure include, but are not limited to the following.

Included facility services:
�� Nursing, technician, and related services;
�� Use of the facility where the surgical procedures are performed;
�� Any laboratory testing performed under a CLIA certificate of waiver;
�� Drugs and biologicals for which separate payment is not allowed under the hospital
outpatient prospective payment system (OPPS); (effective January 1, 2008)
�� Medical and surgical supplies not on pass-through status; (effective January 1, 2008)
�� Equipment;
�� Surgical dressings;
�� Implanted prosthetic devices, including intraocular lenses (IOLs), and related accessories
and supplies not on pass-through status; (effective January 1, 2008)
�� Implanted DME and related accessories and supplies not on pass-through status; (effective
January 1, 2008)
�� Splints and casts and related devices;
�� Radiology services for which separate payment is not allowed under the OPPS, and other
diagnostic tests or interpretive services that are integral to a surgical procedure; (effective January 1, 2008)
�� Administrative, recordkeeping and housekeeping items and services;
�� Materials, including supplies and equipment for the administration and monitoring of anesthesia; and
�� Supervision of the services of an anesthetist by the operating surgeon.