Payment methodolgy for ASC

Certain services may be furnished in ASCs and billed by the appropriate certified provider or supplier
or, in certain cases, billed by the ASC facility itself and paid outside the ASC payments for covered
surgical procedures or covered ancillary services.

The chart shown here gives examples of payment and billing for items or services that are not included
in the ASC payments for covered surgical procedures or covered ancillary services.
Beginning in CY 2008, about 3,400 procedures are approved for ASC payment and categorized into
one of several hundred payment groups. In the November 2007 OPPS/ASC final rule, the budget
neutrality adjustment for CY 2008 is 65 percent of the OPPS payment rates for the same surgical
procedures.

Beginning in CY 2008, there will be a four-year transition period for implementation of the revised ASC
payment system, with the exception of Healthcare Common Procedure Coding System codes newly
payable in the ASC setting, as described below:

• CY 2008—Payment rates will consist of 25 percent of the CY 2008 revised ASC rate plus 75
percent of the CY 2007 ASC rate;
• CY 2009—Payment rates will consist of 50 percent of the CY 2008 revised ASC rate plus 50
percent of the CY 2007 ASC rate;
• CY 2010—Payment rates will consist of 75 percent of the CY 2008 revised ASC rate plus 25
percent of the CY 2007 ASC rate; and
• Beginning in CY 2011—Payment rates will be calculated according to policies of the revised
payment system.

Modified payment methodologies will be used to establish ASC payment rates for new, office-based
procedures, device-intensive procedures, separately payable radiology services, separately payable
drugs and biologicals, and brachytherapy sources.