Ambulatory Surgical Center (ASC) Facility: Services Reimbursed Separately
Published 05/29/2020
A single payment is made to an ASC which includes all "facility services" furnished by the ASC in connection with a covered procedure. However, a number of items and services covered under Medicare that may be furnished in an ASC are not considered facility services. Separate payment may be made for these services, which includes:
- Professional physician and anesthesia services
- Durable medical equipment (DME) for use in patients' homes
- Prosthetic devices (includes implants) — except intraocular lenses (IOLs)
- Ambulance services
- Artificial legs, arms and eyes
- Services furnished by an independent laboratory
- Corneal tissue handling charge
References
- Ambulatory Surgical Center (ASC) Payment CMS web page for a listing of covered procedures
- CMS Medicare Benefit Policy Manual (PDF, 1.28 MB) (Pub. 100-02), chapter 15, sections 260.2 and 260.4
- CMS Medicare Claims Processing Manual (PDF, 182 KB) (Pub. 100-04), chapter 14
- ASC final rule (PDF, 1.1 MB) (CMS-1517-F) regarding the revised payment system (Federal Register)
- Palmetto GBA Modifier Lookup: access from the home page