HI 00610.302 Ambulatory Surgery

In order to provide beneficiaries and physicians with incentives to use less costly alternatives to inpatient hospital facilities for surgical procedures which may be safely and effectively performed on an ambulatory basis, Part B of Medicare provides special reimbursement for services furnished in connection with certain ambulatory surgical centers (ASCs).

1. A. 

   These rules pertain only to surgical procedures specified by the Secretary on a list published periodically in the Federal Register and included in the Medicare Carriers Manual. For information about particular surgical procedures, contact the Medicare carrier. Each ASC also has a copy of the Federal Register list. Other surgical procedures not included in the list are not reimbursable under these provisions.

2. B. 

   ASCs are distinct entities (either hospital-based or free-standing) which operate exclusively for the purpose of furnishing outpatient surgical services to patients, enter into agreements with CMS to do so, and meet the conditions set forth in 42 CFR 416.20 to 416.75. ASCs are reimbursed on the basis of a prospective rate established by CMS for facility services furnished in connection with covered surgical procedures.

3. C. 

   Medicare will pay a physician 100 percent of reasonable charges for services (including pre- and post-operative services) furnished in connection with ASC covered surgical procedures if:

   1. 1. 

      The services that are furnished are on the ASC list;

   2. 2. 

      The surgical procedures are performed in a participating ASC, on an outpatient basis in a hospital or in a hospital affiliated ambulatory surgical center; and

   3. 3. 

      The physician accepts assignment for those services.