Is the procedure performed in the hospital or outpatient surgery center?
In the past, the procedure has often been performed in a hospital setting; however, as of January 1, 2004, CMS has added the “non-facility” (office) setting as an acceptable site of service if adequate equipment is available (see the Federal Register dated January 7, 2004 at www.gpoaccess.gov/fr). Necessary equipment includes not only satisfactory imaging devices but also state-of-the-art monitoring equipment for conscious sedation as well as resuscitation devices. Percutaneous Vetebroplasty is not included in the Medicare-approved ASC list and therefore, there is no separate payment of the ASC facility fee. However, per Medicare Program Memorandum dated July 18, 2001 (www.cms.hhs.gov/manuals), physicians may bill Medicare for procedures performed in the ASC but not listed on the Medicare-approved ASC list. Reimbursement will be made to the physician at the non-facility (office) rate. Physicians may find that they need to negotiate a payment with the ASC in order to properly compensate
