Medicare-Certified Ambulatory Surgical Center Payment Policy

Medicare payment is made for facility services and covered ancillary services furnished to Medicare beneficiaries by a participating ASC in connection with covered surgical procedures. Examples of facility services for which payment is packaged into the ASC payment for a covered surgical procedure include:

• Nursing, technician, and related services;
• Use of the facility where the surgical procedures are performed;
• Any laboratory testing performed under a Clinical Laboratory Improvement  Amendments of 1988 (CLIA) certificate of waiver;
• Drugs and biologicals for which separate payment is not allowed under the OPPS;
• Medical and surgical supplies not on pass-through status under the OPPS;
• Equipment;
• Surgical dressings;
• Implanted prosthetic devises, including intraocular lenses, and related accessories and
• supplies not on pass-through status under the OPPS;
• Implanted DME and related accessories and supplies not on pass-through status under the OPPS;
• 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;
• 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.
Covered ancillary services include ancillary items and services that are integral to a covered surgical procedure for which separate payment is allowed. Covered ancillary services include:
• Brachytherapy sources;
• Certain implantable items that have pass-through status under the OPPS;
• Certain items and services that CMS designates as contractor-priced, including, but not limited to, the procurement of corneal tissue;
• Certain drugs and biologicals for which separate payment is allowed under the OPPS; and
• Certain radiology services for which separate payment is allowed under the OPPS.
The beneficiary coinsurance for ASC covered surgical procedures and a covered ancillary service is 20 percent except as discussed below. CMS waives the coinsurance, the Part B deductible or both for certain preventive services recommended by the United States Preventive Services Task Force with a grade of A or B for any indication or population and that are appropriate for the individual, and the Part B deductible for colorectal cancer screening tests that become diagnostic.