Monday, July 26, 2010

OWCP ASC payment

 Payment Policy for ASC Services in the Facility Payment.

OWCP pays the lesser of the billed charge (the ASC’s usual and customary fee) or the maximum allowed rate.  The base maximum allowable rate for any ASC surgical procedure is 200% of the maximum allowable rate for physician’s professional charge as determined from RVU and conversion factor values associated with each HCPCS code, and from GPCI values associated with site of service.

State waiver:  Ambulatory surgery services provided in a hospital-based ambulatory surgical center in Maryland are exempt from this section.  The Maryland Health Services Cost Review Commission establishes rates for hospital-based ambulatory surgery services in Maryland.  Since Maryland hospitals are required to bill these rates, reimbursement for ambulatory services is to be based on the billed charge.  Freestanding non-hospital based ambulatory surgical centers in the state of Maryland are not covered under the Maryland state waiver for hospital inpatient, hospital outpatient and hospital-based ambulatory surgical centers.

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