Tuesday, July 6, 2010

ASC payment - Not inclusive list of ancillary services

ASCs must incorporate charges for packaged services into the charges reported for the separately payable services with which they are provided. Because contractors pay the lesser of 80 percent of actual charges or the ASC payment rate for the separately payable procedure, and because this comparison is made at the claim line-item level, facilities may not be paid appropriately if they unbundle charges and report those charges for packaged codes as separate line-item charges.
There is a payment adjustment for insertion of an IOL approved as belonging to a class of
NTIOLs, for the 5-year period of time established for that class.

Covered ancillary items and services that are integral to a covered surgical procedure, and for
which separate payment to the ASC is allowed are identified below.

Covered ancillary services:

�� Brachytherapy sources;
�� Certain implantable items that have pass-through status under the OPPS;
�� Certain items and services that CMS designates as contractor-priced, including, but not
limited to, the procurement of corneal tissue;
�� Certain drugs and biologicals for which separate payment is allowed under the OPPS;
�� Certain radiology services for which separate payment is allowed under the OPPS.

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