Under Part B, coverage for surgical dressings is limited to primary dressings, i.e., therapeutic and protective coverings applied directly to lesions on the skin or on openings to the skin required as the result of surgical procedures. (Items such as Ace bandages, elastic stockings and support hose, Spence boots and other foot coverings, leotards, knee supports, surgical leggings, gauntlets and pressure garments for the arms and hands are used as secondary coverings and therefore are not covered as surgical dressings.) Although surgical dressings usually are covered as “incident to” a physician’s service in a physician’s office setting, in the ASC setting, such dressings are included in the facility’s services.
However, surgical dressings may be reapplied later by others, including the patient or a member of his family. When surgical dressings are obtained by the patient on a physician’s order from a supplier, e.g., a drugstore, the surgical dressing is covered under Part B and paid by the Durable Medical Equipment Medicare Administrative Contractor (DME MAC). Similarly, “other supplies, splints, and casts” include only those furnished by the ASC at the
time of the surgery. Additional covered supplies and materials furnished later are generally furnished as “incident to” a physician’s service, not as an ASC facility service. The term “supplies” includes those required for both the patient and ASC personnel, e.g., gowns, masks, drapes, hoses, and scalpels, whether disposable or reusable. These are included in the rate for the surgical procedure.
ASC Facility Payment for drugs and biologicals includes those drugs and biologicals that are not usually self administered and that are considered to be packaged into the payment for a surgical procedure under the OPPS. Also, Medicare makes separate payment for ASC drugs and biologicals that are furnished integral to an ASC covered surgical procedure and are separately payable under the OPPS.
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