ASC Procedures Covered for Payment.

ASC Procedure Covered and Non covered payment in DOL (OWCP)


ASC Procedures Covered for Payment.

All procedures covered by OWCP in an ASC are listed in the list of surgical procedures allowable for facility fee payment to Ambulatory Surgical Center (file name:  fs09asc_pymt_grp.xls) available online at: 

http://www.dol.gov/esa/OWCP/regs/feeschedule/fee.htm

Note that inclusion in this list does not mean that a procedure is automatically payable.  Prior authorization for elective procedures, appropriateness to the accepted condition and other program requirements must also be met.

ASC Procedures Not Covered for Payment.

Surgical procedures that are not included in the list of surgical procedures allowable for facility fee payment to Ambulatory Surgical Center are not covered in an ASC setting.  This list does not include procedures that are currently performed on an ambulatory basis in a physician’s office and that do not generally require the more elaborate facilities of an ASC.  Neither does the list include procedures that are appropriately performed in an inpatient hospital setting but would not be safely performed in an ASC.  We recognize that there are some procedures that might be appropriately performed in ASC for the younger patient who is generally healthy.  But for the larger number of OWCP beneficiaries whose health is more likely to be compromised by disability and age, an ASC may be a questionable setting for those same procedures.  Therefore, we are including in the list only those procedures that can be safely performed in an ASC on the general OWCP population in at least a significant number of cases.  The resulting list of procedures allows ASCs to furnish OWCP beneficiaries with a broad range of surgical services that reflect the practice of contemporary surgery without compromising patient safety.