BILLING - Independent Laboratory AND Ancillary Services

Services of Independent Laboratory

Only a very limited number and type of diagnostic tests are considered ASC facility services and these are included in the ASC payment for covered surgical procedures. In most cases, diagnostic tests performed directly by an ASC are not considered ASC facility services and are not covered under Medicare. Section 1861(s) of the Act limits coverage of diagnostic lab tests in facilities other than physicians’ offices, rural health clinics or hospitals to facilities that meet the statutory definition of an independent laboratory. To bill for diagnostic tests as a laboratory, an ASC’s laboratory must be CLIA certified and enrolled with the contractor as a laboratory, and the certified clinical laboratory must bill for the services provided to the beneficiary in the ASC. Otherwise, the ASC makes arrangements with a covered laboratory or laboratories for laboratory services, as provided in 42 CFR 416.49 (http://www.access.gpo.gov/nara/cfr/waisidx_06/42cfr416_06.html).

Effective January 1, 2008, the following ancillary items and services are considered for separate payment when performed as an integral procedure to a covered surgical procedure:

• Covered ancillary services.
• Brachytherapy sources.
• Certain implantable items that have pass-through status under OPPS.
• Certain drugs and biologicals for which separate payment is allowed under OPPS.
• Certain items that CMS designates as contractor-priced, including, but not limited to, procurement of corneal tissue.
• Certain radiology services for which separate payment is allowed under OPPS.
• Certain items/services CMS designates as contractor-priced, including but not limited to, the procurement of corneal tissue.

Ancillary Services

Medicare pays separate for certain covered ancillary services that are provided integral to covered surgical procedures in ASCs. The ancillary services must be provided immediately before, during, or after a covered surgical procedure to be considered integral and thereby, eligible for separate payment. Medicare also will provide separate payment to the ASC for drugs, devices that are eligible for pass-through payment under OPPS. Payment can also be made for covered ancillary radiology services made to ASCs. ASCs will only receive payment for the technical component of the covered ancillary radiology procedure.