Procedure billing in ASC setup

Procedure Coding 

The Colorado Medical Assistance Program provides benefits for medically necessary services. An ASC is an entity that operates exclusively for the purpose of furnishing surgical procedures that do not require hospitalization. An ASC may be part of a hospital, but only if the building space utilized by the ASC is physically separated from other health services offered by a hospital.

Medicaid-enrolled ASC providers must be certified by the Centers for Medicare and Medicaid Services (CMS) to participate in the Medicare program as an ASC. The facility must also be licensed by the CDPHE.

For payment purposes, ASC surgical procedures are grouped into ten (10) reimbursement categories. The Coloado Medical Assistance Program uses the Healthcare Common Procedural Coding System (HCPCS) to identify surgical services. HCPCS includes all codes published in the American Medical Association's (AMA) Current Procedural Terminology (CPT) and HCPCS Level II codes published by CMS. The AMA and CMS publish annual coding revisions. Medicaid bulletins notify providers when annual coding updates are implemented.

Refer to the end of this manual for a complete list of the Medicaid-approved ASC procedure codes effective January 1, 2014. The list is divided into related groups for payment. Only surgical procedure codes that are published in this manual are an ASC Medicaid benefit