Tuesday, June 29, 2010

ASC facility services payment

Medicare makes a single payment to ASCs for covered services, which includes ASC facility services
that are furnished in connection with a covered procedure.

Examples of covered ASC facility services that are paid through the payment for covered surgical
procedures include the following:
• Nursing services, services furnished by technical personnel, and other related services;
• Patient use of ASC facilities;
• Drugs and biologicals for which separate payment is not allowed under the OPPS, surgical
dressings, supplies, splints, casts, appliances, and equipment;
• Administrative, recordkeeping, and housekeeping items and services;
• Blood, blood plasma, and platelets, with the exception of those to which the blood deductible
• Materials for anesthesia;
• Intraocular lenses;
• Implantable devices, with the exception of those devices with pass-through status under the OPPS;
• Radiology services for which payment is packaged under the OPPS

Medicare also pays ASCs separately for covered ancillary services that are integral to a covered
surgical procedure billed by the ASC, specifically certain services that are furnished immediately
before, during, or immediately after the covered surgical procedure. Covered ancillary services include:

• Drugs and biologicals that are separately paid under the OPPS;
• Radiology services that are separately paid under the OPPS;
• Brachytherapy sources;
• Implantable devices with OPPS pass-through status; and
• Corneal tissue acquisition

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