Friday, July 9, 2010

Definitions of covered ASC facility services include:

�� Administrative, Recordkeeping and Housekeeping Items and Services 
These include the general administrative functions necessary to run the facility e.g., scheduling, cleaning, utilities, and rent.

�� Anesthesia Materials
These include the anesthetic itself, and any materials, whether disposable or re-usable, necessary for its administration.

�� Blood, Blood Plasma, Platelets, etc., Except Those to Which Blood Deductible Applies
While covered procedures are limited to those not expected to result in extensive loss of
blood, in some cases, blood or blood products are required. Usually the blood deductible
results in no expenses for blood or blood products being included under this provision.
However, where there is a need for blood or blood products beyond the deductible, they are
considered ASC facility services and no separate charge is permitted to the beneficiary or the

�� Diagnostic or Therapeutic Items and Services
These are items and services furnished by ASC staff in connection with covered surgical procedures. Many ASCs perform diagnostic tests prior to surgery that are generally included
in the facility charges, such as urinalysis, blood hemoglobin, hematocrit levels, etc. To the
extent that such simple tests are included in the ASC’s facility charges, they are considered
facility services. However, under the Medicare program, diagnostic tests are not covered in
laboratories independent of a physician’s office, rural health clinic, or hospital unless the
laboratories meet the regulatory requirements for the conditions for coverage of services of
independent laboratories. Therefore, diagnostic tests performed by the ASC other than those
generally included in the facility’s charge are not covered under Part B and are not to be
billed as diagnostic tests. If the ASC has its laboratory certified, the laboratory itself may bill
for the tests performed.

The ASC may make arrangements with an independent laboratory or other laboratory, such
as a hospital laboratory, to perform diagnostic tests it requires prior to surgery. In general,
however, the necessary laboratory tests are done outside the ASC prior to scheduling of
surgery, since the test results often determine whether the beneficiary should have the
surgery done on an outpatient basis in the first place.

�� Drugs, Biologicals, Surgical Dressings, Supplies, Splints, Casts, Appliances, and

This category includes all supplies and equipment commonly furnished by the ASC in
connection with surgical procedures. See the following paragraphs for certain exceptions.
Drugs and biologicals are limited to those which cannot be self-administered.

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