Q: In your experience, what are some of the essential pieces of equipment and their average costs for starting a pain management service line in an ASC?
Amy Mowles, President and CEO, Mowles Medical Practice Management: Here is what centers will need:
∙ Good quality C-arm. New C-arms cost around $130,000. A slightly used or
even a demo model can be a great purchase from around $45K as long as the
parts are available and you have a solid contract with someone who can fix
it immediately.
∙ Radiofrequency units. $25,000 - $35,000
∙ Supply inventory. From $15K-$25K (per approximately 20 procedures a day/five days a week)
Breakdown:
| Item description | Cost/case |
| Epidural tray | $10 - $20 |
| Contrast dye | $20 - $30 |
| Equipment | $60 - $100 |
| Staffing | $30 - $50 |
| TOTAL: | $120 - $200 ($200 would be very high) |
Q: Are there ways in which ASCs can minimize these costs?
AM: Negotiate on custom trays. Look at reputable remanufacturers on some items, but not patient monitors.
Q: What are the average payments/reimbursements ASCs receive for pain management?
AM: The commercial payor market reimbursement for pain procedures varies
significantly throughout the United States. Oregon and Alaska being the highest, Maryland and Pennsylvania the lowest. In a heavy managed care market I would not expect most payors with a large market share in a given area to be much more then Medicare plus or minus that wage index up to 130 percent Medicare.
Typical procedures with Mediare national average:
| CPT | Short description | ASC facility fee |
| 27096 | Inject sacroiliac joint | $295.98 |
| 62311 | Inject spine l/s (cd) | $295.98 |
| 64483 | Inj foramen epidural l/s | $295.98 |
| 64490 | Facet Joint Inj | $288.44 |
| 64622 | Destr paravertebrl nerve l/s | $477.56 |
| 64623 | Destr paravertebrl addtl | $295.98 |
Q: What are the average procedure times for common ASC pain procedures?
AM: Most procedures require 15 minutes of actual time in the procedure room. Remember, though, that each patient encounter of 15 minutes can generate several facility fees. Billable procedures rather than encounters is key.
Q: What kinds of staff members are needed for pain procedures in ASCs?
AM: Centers will need, typically, depending on the number of cases, two RNs, 1-2 CRTs and 1-2 MAs.
Q: What kinds of anesthesia are needed for pain procedures?
AM: The vast majority are under moderate sedation with the provider of the procedure directing the RN to administer and monitor the sedation. Depending on the patients, though, we often see a separate anesthesia provider for MAC.
Post-procedure fits nicely in step down with recliners. Typically 10-20 minutes.
Remember that most patients spend more time in pre- and post-op so make sure those spaces are well-designed and pleasant.
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