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Physicians’ services
Physicians who perform covered services in ASCs receive separate payment under Part B. Such services include:
- Anesthesiologists administering or supervising the administration of anesthesia to ASC patients and the patients’ recovery from the anesthesia;
- Routine pre- or post- operative services, such as office visits, consultations, diagnostic tests, suture removal, dressing changes, and other services which are usually included in the physician fee for a given surgical procedure. | Physician | Carrier |
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Non-implantable durable medical equipment (DME) to ASC patients for in-home use
ASCs who sell, lease, or rent items of DME to patients, are treated as DME suppliers. All of the ordinary DME-applicable rules and conditions apply to the ASC, including obtaining a supplier number and billing the DMERC as required. | Supplier
An ASC can be a supplier of DME if it has a DME supplier number from the National Supplier Clearinghouse. | DMERC |
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Implantable DME and accessories
ASCs who furnish implantable DME items to patients, bill the local carrier for the surgical procedure and the implantable device. | ASC | Carrier |
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Non-implantable prosthetic devices
ASCs who furnish non-implantable prosthetic devices to patients are treated as suppliers, and all the ordinary DME-applicable rules and conditions apply to the ASC, including obtaining a supplier number and billing the DMERC as required. | Supplier
An ASC can be a supplier of non-implantable prosthetics if it has a supplier number from the National Supplier Clearinghouse. | DMERC |
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Implantable prosthetic devices except intraocular lenses (IOLs and NTIOLs [new technology intraocular lenses]), and accessories
ASCs may bill and receive separate payment for prosthetic devices (other than intraocular lenses [IOLs]) that are implanted, inserted, or otherwise applied by surgical procedures on the ASC list of approved procedures. The ASC bills the local Carrier and receives payment according to the DMEPOS fee schedule.
An intraocular lens (IOL) inserted during or subsequent to cataract surgery in an ASC is included in the facility payment rate. ASCs may receive additional payment for approved NTIOLs that are furnished in an ASC during or subsequent to certain cataract procedures. | ASC | Carrier |
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Ambulance services
ASCs who furnish ambulance services, may obtain approval as ambulance suppliers to bill covered ambulance services. | Certified ambulance supplier | Carrier |
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Leg, arm, back, and neck braces
These items of equipment are not included in the ASC facility payment amount, but are covered under Part B.
ASCs who furnish these items to patients are treated as suppliers, and all the rules and conditions ordinarily applicable to suppliers apply to the ASC, including obtaining a supplier number and billing the DMERC as required. | Supplier | DMERC |
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Artificial legs, arms, and eyes
These items of equipment are not included in the ASC facility payment rate, but are covered under Part B.
ASCs who furnish these items to patients are treated as suppliers, and all the rules and conditions ordinarily applicable to suppliers apply to the ASC, including obtaining a supplier number and billing the DMERC as required. | Supplier | |
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Services furnished by an independent laboratory
Only very limited numbers and types of diagnostic tests are considered ASC facility services and these are included in the ASC facility payment rate.
Since coverage of diagnostic lab tests in facilities other than physicians’ offices, rural health clinics or hospitals is limited to facilities that meet the statutory definition of an independent laboratory, in most cases diagnostic tests performed directly by an ASC are not considered ASC facility services (in fact are usually not covered under Medicare). ASC laboratories must be CLIA certified and will need to enroll with the carrier as a laboratory. Otherwise, the ASC makes arrangements with a covered laboratory or laboratories for laboratory services. If the ASC has a certified independent laboratory, the laboratory itself bills the carrier. | Certified lab. ASCs can receive lab certification and a CLIA number. | Carrier |
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Procedures NOT on the ASC list
Physicians bill the carrier for the procedures and any implantable prosthetics/DME, using the ASC as the place of service | Physician | Carrier |
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