What POS and TOS can be used for ASC facility

ASC Procedures for Completing the ASC X12 837 Professional Claim Format or the Form CMS-1500 

The Place of Service (POS) code is 24 for procedures performed in an ASC.
Prior to January 1, 2008, type of Service (TOS) code is “F” (ASC Facility Usage for Surgical Services) is appropriate when modifier SG appears on an ASC claim. Otherwise TOS “2” (surgery) for professional services rendered in an ASC is appropriate. Beginning January 1, 2008, ASCs no longer are required to include the SG modifier on facility claims in Medicare. The contractors shall assign TOS code “F” to codes billed by specialty 49 for Place of Service 24.

Modifier - TC is required unless the code definition is for the technical component only.



 Medicare Summary Notices (MSN), Claim Adjustment Reason Codes, Remittance Advice Remark Codes (RAs) 


Contractors shall return as unprocessable any claims for NTIOLs containing Q1003 alone or with a code other than one of the procedure codes listed in 40.3. Use the following messages for these returned claims:

• Claim Adjustment Reason Code 16 - Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remark codes whenever appropriate.

• RA Remark Code M67 - Missing/Incomplete/Invalid other procedure codes.

• RA Remark Code MA130 - Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.

Contractors shall deny payment for Q1003 if services are furnished in a facility other than a Medicare-approved ASC. Use the following messages when denying these claims:
• MSN 16.2 - This service cannot be paid when provided in this location/facility.

• Claims Adjustment Reason Code 58 - Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.

Contractors shall deny payment for Q1003 if billed by an entity other than a Medicare-approved ASC. Use the following messages when denying these claims:
• MSN 33.1 - The ambulatory surgical center must bill for this service.

• Claim Adjustment Reason Code 170 - Payment is denied when performed/billed by this type of provider.

Contractors shall deny payment for Q1003 if submitted for payment past the discontinued date (after the 5-year period, or after February 26, 2011). Use the following messages when denying these claims:
• MSN 21.11 - This service was not covered by Medicare at the time you received it.

• Claim Adjustment Reason Code 27 - Expenses incurred after coverage terminated.

Carriers shall deny payment for Q1003 if services are furnished in a facility other than a Medicare-approved ASC. Use the following messages when denying these claims:
• MSN 16.2 - This service cannot be paid when provided in this location/facility.

• Claims Adjustment Reason Code 58 - Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.

Carriers shall deny payment for Q1003 if billed by an entity other than a Medicare-approved ASC. Use the following messages when denying these claims:
• MSN 33.1 - The ambulatory surgical center must bill for this service.

• Claim Adjustment Reason Code 170 - Payment is denied when performed/billed by this type of provider.

Carriers shall deny payment for Q1003 if submitted for payment past the discontinued date (after the 5-year period, or after February 26, 2011). Use the following messages when denying these claims:
• MSN 21.11 - This service was not covered by Medicare at the time you received it.

• Claim Adjustment Reason Code 27 - Expenses incurred after coverage terminated.