Services covered under ASC facility setup

ASC Covered Procedures/Services

Payment can be made under Part B for certain surgical procedures that were furnished in ASCs and were approved for being furnished in an ASC. These procedures were those that generally did not exceed 90 minutes and did not require more than four hours of recovery or convalescent time. The surgical codes included on the ASC list of covered surgical procedures are those that have been determined to pose no significant safety risk to Medicare beneficiaries when furnished in ASCs and that are not expected to require active medical monitoring at midnight of the day on which the surgical procedure is performed (overnight stay).

CMS does not expect these unsafe services to be furnished to Medicare beneficiaries and expects that physicians and ASCs will advise beneficiaries of all the possible consequences (including no Medicare ASC payments with concomitant beneficiary liability and significant surgical risk) if surgical procedures excluded from ASC payment were to be provided in ASCs.

Prior to January 1, 2008, Medicare did not pay an ASC for those procedures that require more than an ASC level of care or for minor procedures that were normally performed in a physician’s office.
CMS will pay separately 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 will also provide a separate payment to the ASC for drugs and devices that are eligible for pass-through payment under OPPS.

ASCs may also receive reimbursement for radiology and certain other imaging services. Separate payment for the technical component of the covered ancillary radiology services can be paid to the ASC under the OPPS.
Medicare will also pay separately for all drugs and biologicals that are separately paid under the OPPS when they are provided integral to covered surgical procedures.

Medicare will make separate payment (at contractor-priced rates) for devices that have pass-through status under OPPS when the devices are an integral part of a covered surgical procedure.

Separate payment for brachytherapy sources will also be considered for payment either under the OPPS rates or contractor-priced if OPPS rates are unavailable.