ASC services - Diagnostic or Therapeutic and Administrative, Recordkeeping and Housekeeping

Diagnostic or Therapeutic Items and Services

Diagnostic or therapeutic items and services are items and services furnished by ASC staff in connection with covered surgical procedures. Many ASCs perform diagnostic tests prior to surgery that are generally included in the facility charges, such as urinalysis, blood hemoglobin, hematocrit levels, etc. To the extent that such simple tests are included in the ASC facility charges, they are considered facility services. However, under the Medicare program, diagnostic tests are not covered in laboratories independent of a physician’s office, rural health clinic or hospital unless the laboratories meet the regulatory requirements for the conditions for coverage of services of independent laboratories. (See 42CFR416.49 at http://www.access.gpo.gov/nara/cfr/waisidx_06/42cfr416_06.html.) Therefore, diagnostic tests performed by the ASC other than those generally included in the facility’s charge are not covered under Part B and are not to be billed as diagnostic tests.
If the ASC has its laboratory certified, the laboratory itself may bill for the tests performed.

The ASC may make arrangements with an independent laboratory or other laboratory, such as a hospital laboratory, to perform the diagnostic tests it requires prior to surgery. In general, however, the necessary laboratory tests are done outside the ASC prior to scheduling of surgery, since the test results often determine whether the beneficiary should have the surgery done on an outpatient basis in the first place.

Beginning January 1, 2009, the ordering/referring physician must be reported on claims for diagnostic services submitted by the ASC.

Administrative, Recordkeeping and Housekeeping Items and Services

Administrative, recordkeeping and housekeeping items and services include the general administrative functions necessary to run the facility, e.g., scheduling, cleaning, utilities and rent.

Blood, Blood Plasma, Platelets, Etc., Except Those to Which Blood Deductible Applies

While covered procedures are limited to those not expected to result in extensive loss of blood, in some cases, blood or blood products are required. Usually the blood deductible results in no expenses for blood or blood products being included under this provision. However, when there is a need for blood or blood products beyond the deductible, they are considered ASC facility services and no separate charge is permitted to the beneficiary or the program.