what is prosthetic devices - ASC billing

Prosthetic Devices

Prior to January 1, 2008, an ASC was allowed to bill and receive separate payment for implantable prosthetic devices other than IOLs that were implanted, inserted or otherwise applied by surgical procedures on the ASC list of approved procedures. The ASC billed the local contractor and receives payment according to the Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule. However, an IOL inserted during or subsequent to cataract surgery in an ASC was included in the facility payment rate.

Effective January 1, 2008, payment for implantable prosthetic devices without OPPS pass-through status is included in the ASC payment for the covered surgical procedure. ASCs may not bill separately for implantable devices without OPPS pass-through status.

If the ASC furnishes other non-implantable prosthetic devices to beneficiaries, the ASC is treated as a supplier and all the rules and conditions ordinarily applicable to suppliers are applicable, including obtaining a supplier number and billing as directed by the jurisdiction list.