Reimbursement of ASC procedures is based on the Centers for Medicare & Medicaid Services (CMS)-approved Ambulatory Surgical Code Groupings (1 through 9 per CMS and Group 10 per HHSC) payment schedule. When multiple surgical procedures are performed on the same day, only the procedure with the highest surgical code grouping is reimbursed. A complete list of approved ASC procedure codes with the assigned payment group can be found on the TMHP website at www.tmhp.com. Click on Fee Schedules. This list can also be obtained by calling the TMHP Contact Center at 1-800-925-9126.
ASC Global Services
The ASC payment represents a global payment and includes room charges and supplies. Covered services provided are billed as one inclusive charge. All facility services provided in conjunction with the surgery (e.g., laboratory, radiology, anesthesia supplies, medical supplies) are considered part of the global payment and cannot be itemized or billed separately. Routine X-ray and laboratory services directly related to the surgical procedure being performed are not reimbursed separately. All nonroutine laboratory and X-ray services provided with emergency conditions may be
billed separately with documentation that the complicating condition arose after the initiation of the surgery. No separate payment outside of the ASC reimbursement rate will be made for prosthetic devices. Medical and prosthetic devices such as implantable pumps and intraocular lenses may be supplied by the ASC and implanted, inserted, or otherwise applied during a covered
surgical procedure.
Exception: Certain pieces of equipment, (e.g., cochlear implant and neurostimulator devices) may be reimbursed separately from the ASC global rate.
Physician and certified registered nurse anesthetist (CRNA) services performed in an ASC must be billed under the physician or CRNA provider identifier and are reimbursed separately.
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