Medicare

Medicare Claims Processing Manual
Chapter 14 - Ambulatory Surgical Centers
Table of Contents
(Rev. 2020, 08-06-10)

Transmittals for Chapter 14
Crosswalk to Old Manuals
10 - General
10.1 - Definition of Ambulatory Surgical Center (ASC)
10.2 - Ambulatory Surgical Center Services on ASC List
10.3 - Services Furnished in ASCs Which Are Not ASC Facility Services or
Covered AncillaryServices
10.4 - Coverage of Services in ASCs Which Are Not ASC Facility Services or
Covered Ancillary Services
20 - List of Covered Ambulatory Surgical Center Procedures
20.1 - Nature and Applicability of ASC List
20.2 - Types of Services Included on the List
20.3 - Rebundling of CPT Codes
30 - Rate-Setting Policies
30.1 - Where to Obtain Current Rates and Lists of Covered Services
40 - Paymentfor Ambulatory Surgery
40.1 - Payment to Ambulatory Surgical Centers for Non-ASC Services
40.2 - Wage Adjustment of Base Payment Rates
40.3 - Payment for Intraocular Lens (IOL)
40.4 - Payment for Terminated Procedures
40.5 - Payment for Multiple Procedures
40.6 - Payment for Extracorporeal Shock Wave Lithotripsy (ESWL)
40.7 - Payment for Pass-Through Devices Beginning January 1, 2008
40.8- Payment When a Device is Furnished With No Cost or With Full or Partial
Credit Beginning January 1, 2008
40.9 - Payment and Coding for Presbyopia Correcting IOLs (P-C IOLs) and
Astigmatism Correcting IOLs (A-C IOLs)
50 - ASC Procedures for Completing the Form CMS-1500

60 - Medicare Summary Notices (MSN) Claim Adjustment Reason Codes, Remittance
Advice Remark Codes (RAs)
60.1 -Applicable messages for NTIOLs
60.2 - Applicable Messages for ASC 2008 Payment Changes Effective January 1,
2008
60.3 - Applicable Messages for Certain Payment Status Indicators on the ASCFS
Effective for Services on or after January 1, 2009
70 - Ambulatory Surgical Center (ASC) HCPCS Additions, Deletions, and Master
Listing

10 - General
(Rev. 1514; Issued: 05-23-08; Effective: 01-01-08;Implementation: 06-23-08)
Prior to January 1, 2008, payment was made under Part B for certain surgical procedures
that were furnished in ASCs and were approved for being furnished in an ASC. These
procedures were those that generally did not exceed 90 minutes in length and did not
require more than 4 hours of recovery or convalescent time. Prior to January 1, 2008,
Medicare did not pay an ASC forthose procedures that required more than an ASC level
of care, or for minor procedures that were normally performed in a physician’s office.
Prior to January 1, 2008, the CMS published updates to the list of procedures for which
an ASC may be paid each year. The complete list of procedures is available on the CMS
Web site at: http://www.cms.hhs.gov/ascpayment/. These files include applicablecodes,
payment groups, and payment amounts for each ASC group before adjustments for
regional wage variations. Applicable wage indices were also published via change
requests.
Beginning January 1, 2008, payment is made to ASCs under Part B for all surgical
procedures except those that CMS determines may pose a significant safety risk to
beneficiaries or that are expected to require anovernight stay when furnished in an ASC.
Also, beginning January 1, 2008, separate payment is made to ASCs under Part B for
certain ancillary services such as certain drugs and biologicals, OPPS pass-through
devices, brachytherapy sources, and radiology procedures. Medicare does not pay an
ASC for procedures that are excluded from the list of covered surgical procedures.
Medicare continues to payASCs for new technology intraocular lenses and corneal tissue
acquisition as it did prior to January 1, 2008.
Beginning January 1, 2008, the CMS publishes updates to the list of procedures for which
an ASC may be paid each year. In addition, CMS publishes quarterly updates to the lists
of covered surgical procedures and covered ancillary services to establish payment
indicators and payment...