Once an ASC is approved for Medicare participation, the ASC can only be reimbursed for procedures that are on a list of procedures that Medicare will reimburse to an ASC. Procedures on the list fall into one of 9 groupings with a payment rate assigned to each group. The payment group is determined by the CPT procedure rendered. The groups actually have no clinical coherence but were based on a cost analysis survey last performed by CMS in 1994.
Medicare Unadjusted National allowances per gr
oup as below were effective October 1, 2002.
GROUP 1 -- $ 333.00
GROUP 2 -- $ 446.00
GROUP 3 -- $ 510.00
GROUP 4 -- $ 630.00
GROUP 6 -- $ 826.00
GROUP 7 -- $ 995.00
GROUP 8 -- $ 973.00
GROUP 9 -- $1339.00 (New)
GROUP 5 -- $ 717.00
Medicare Covered ASC Pain Management Procedures
| CPT | DESCRIPTION | Group |
| 62311 | Epidural lumbar/sacral/caudal | 1 |
| 62310 | Epidural cervical/thoracic. | 1 |
| 62318 | Inject. Incl.cath placement, continuous cervical/thoracic | 1 |
| 62319 | Inject. Incl. Cath placement, continuous lumbar/sacral | 1 |
| 64410 | Phrenic Nerve | 1 |
| 64415 | Brachial Plexus | 1 |
| 64417 | Axillary Nerve Block | 1 |
| 64420 | Intercostal, single | 1 |
| 64421 | Intercostal, multiple | 1 |
| 64430 | Pudental Nerve | 1 |
| 64479 | Transforaminal, epidural cerv/thor, 1st level | 1 |
| 64480 | Transforaminal, epidural cerv/thor, ea. addt’l. | 1 |
| 64483 | Transforaminal epidural lumbar/sacral, 1st level | 1 |
| 64484 | Transforaminal epidural lumbar/sacral, ea. addt'l | 1 |
| 64475 | Facet, lumbar/sacral single | 1 |
| 64476 | Facet, lumbar/sacral addt’l | 1 |
| 64470 | Facet, cervical/thoracic single | 1 |
| 64472 | Facet, cervical/thoracic additional | 1 |
| 64510 | Stellate Ganglion | 1 |
| 64520 | Lumbar sympathetic | 1 |
| 64530 | Celiac Plexus | 1 |
| 62280 | Subarachnoid | 1 |
| G0260 | Inj for sacroiliac jt anesth * | 1 |
| 62282 | Epidural, lumbar/caudal | 1 |
| 64600 | Trigeminal Nerve, any | 1 |
| 62270 | Spinal puncture lumbar | 1 |
| 64620 | Intercostal: destruct | 1 |
| 64622 | Destruct Paravetebral Facet, lumbar single | 1 |
| 64623 | Destruct Paravetebral Facet, lumbar ea. addt’l | 1 |
| 64626 | Facet joint or facet joint nerve cerv/thor, 1st level | 1 |
| 64627 | Facet joint or facet joint nerve cerv/thor, ea. addt’l | 1 |
| 62263 | Percutaneous lysis of adhesions | 1 |
| 62273 | Blood Patch | 1 |
| 64680 | Celiac Plexus: destruct | 2 |
| 62350 | Implant Catheter | 2 |
| 62355 | Remove implanted catheter | 2* |
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