Medicare payment is made for facility services and covered ancillary services furnished to Medicare beneficiaries by a participating ASC in connection with covered surgical procedures. Examples of facility services for which payment is packaged into the ASC payment for a covered surgical procedure include:
Nursing, technician, and related services;
Use of the facility where the surgical procedures are performed;
Any laboratory testing performed under a Clinical Laboratory Improvement Amendments of 1988 (CLIA) certificate of waiver;
Drugs and biologicals for which separate payment is not allowed under the OPPS;
Medical and surgical supplies not on pass-through status under the OPPS;
Equipment;
Surgical dressings;
Implanted prosthetic devises, including intraocular lenses, and related accessories and supplies not on pass-through status under the OPPS;
Implanted DME and related accessories and supplies not on pass-through status under the
OPPS;
Splints and casts and related devices;
Radiology services for which separate payment is not allowed under the OPPS, and other diagnostic tests or interpretive services that are integral to a surgical procedure;
Administrative, recordkeeping, and housekeeping items and services;
Materials, including supplies and equipment for the administration and monitoring of anesthesia; and
Supervision of the services of an anesthetist by the operating surgeon.
Covered ancillary services include ancillary items and services that are integral to a covered surgical procedure for which separate payment is allowed. Covered ancillary services include:
Brachytherapy sources;
Certain implantable items that have pass-through status under the OPPS;
Certain items and services that CMS designates as contractor-priced, including, but not limited to, the procurement of corneal tissue;
Certain drugs and biologicals for which separate payment is allowed under the OPPS;
and Certain radiology services for which separate payment is allowed under the OPPS.
ASCs currently use the form CMS-1500 to submit Medicare claims data. The physician bills for the surgery while the ASC bills for the facility and ancillary charges. Both the ASC and the physician use the appropriate CPT/HCPCS codes on the CMS-1500 form.
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