Services and Items Included at a Minimum in the ASC Reimbursement

1. Use of the facilities where the surgical procedures are performed
2. Nursing, technician, and related services
3. Drugs, biologicals, surgical dressings, supplies, splints, casts, and appliances and equipment directly related to the provision of surgical procedures
4. Diagnostic and therapeutic items and services directly related to the provision of a surgical procedure
5. Administrative, record keeping, and housekeeping items and services
6. All blood products (whole blood, plasma, platelets, etc.)
7. Materials for anesthesia
8. Intra-ocular lenses (IOLs)
9. Supervision of the services of an anesthetist by the operating surgeon

Services That may be Billed Separately 

The following services/items are not included in the ASC rate and may be billed separately by the actual provider of services. 

1. Physician services 

2. Anesthetist services 

3. Laboratory, radiology or diagnostic procedures (other than those directly related to performance of the surgical procedure) 

4. Prosthetic devices (except IOLs) 

5. Ambulance services 

6. Leg, arm, back, and neck braces 

7. Artificial limbs 

8. Durable medical equipment for use in the member’s home