How do ambulatory surgical centers get paid for procedures not on the approved list?
Generally, for CPT codes not on the ASC reimbursable list and that do have facility and non-facility prices, the physician gets reimbursed at a nonfacility level. There may be an arrangement between the physician and ASC where the physician might forward some of the differential amount to the ASC. For CPT codes that have identical reimbursements in and outside a facility, this may or may not be feasible and depends on the arrangement and ownership relationship that the physician and ASC might have. It may not be feasible to perform this procedure in an ASC, but this is not within our judgment and jurisdiction. The carrier does not determine when there is a facility/non-facility fee for a given procedure or what procedures are on the approved list. We receive these instructions from CMS. This list can be seen on the CMS website through the following link under “Ambulatory Surgical Center (ASC) Base Eligibility File”: http://www.cms.hhs.gov/providers/pufdownload/default.asp?
Related Questions
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- How should Ambulatory Surgical Centers (ASCs) report bilateral procedures under the revised ASC payment system?
- How do ambulatory surgical centers get paid for procedures not on the approved list?
