The following Q&A comes from the Centers for Medicare & Medicaid Services website.
Q: Where can I find a list of procedures and ancillary services that are payable in the Ambulatory Surgical Center (ASC) setting and their associated payment rates under the revised ASC payment system?
CMS: ASC covered surgical procedures and associated payment rates are published in Addendum AA of the hospital outpatient prospective payment system (OPPS)/ASC final rule for the relevant payment year and covered ancillary services are in Addendum BB.
Both Addenda AA and BB for CY 2008 are available at www.cms.hhs.gov/ASCPayment/ASCRN/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=3&sortOrder=descending&itemID=CMS1213395&intNumPerPage=10
Quarterly updates are available by accessing the "Addenda Updates" menu link at www.cms.hhs.gov/ASCPayment/
The ASC list of covered procedures merely indicates procedures which are covered and paid if performed in the ASC setting. It does not require the covered surgical procedures to be performed only in ASCs. The decision regarding the most appropriate care setting for a given surgical procedure is made by the physician based on the beneficiary's individual clinical needs and preferences. Also, all general coverage rules requiring that any procedure be reasonable and necessary for the beneficiary are applicable to ASC services in the same manner as all other covered services. See the Medicare Claims Processing Manual, Chapter 14, Section 20.1.
Source: CMS
Read more ASC coding guidance:
- 6 Ambulatory Surgery Center Reimbursement Trends for 2011
- Coding Guidance for Tendon Repairs
- 6 Ways to Prepare for Successful Payor Contract Negotiations