Services Furnished in ASCs Which Are Not ASC Facility Services

10.3 - Services Furnished in ASCs Which Are Not ASC Facility Services or Covered Ancillary Services (Rev. 11793; Issued:01-19-23; Effective: 02-21-23; Implementation: 02-21-23) A single payment is made to an ASC for facility services furnished by the ASC in connection with a covered surgical procedure. Additional payments may be made to the ASC for covered ancillary services, specifically brachytherapy sources, certain implantable devices with pass-through status under the OPPS, corneal tissue acquisition, drugs and biologicals for which separate payment is allowed under the OPPS, radiology services for which separate payment is allowed under the OPPS, and certain other integral services not included in the primary procedure payment. To be covered ancillary services for which separate payment is made, these items and services must be provided integral to covered surgical procedures, that is, immediately before, during, or immediately after the covered surgical procedure. However, a number of items and services covered under Medicare may be furnished in an ASC that are not considered ASC services, and which payment for ASC services does not include. These non-ASC services are covered and paid for under the applicable provisions of Part B. In addition, the ASC may be part of a medical complex that includes other entities, such as an independent laboratory, supplier of durable medical equipment, or a physician’s office, which are covered as separate entities under Part B. In general, an item or service provided in a separate part of the complex is not considered an ASC service, except as defined above. Examples of payment and billing for items or services that are not ASC services: Items not included in payment for ASC services Who may receive payment Submit bills to: Physicians’ services (including surgical procedures excluded from ASC payment) Physician A/B MAC (B) The purchase or rental of non-implantable durable medical equipment (DME) to ASC patients for use in their homes Supplier- An ASC can be a supplier of DME if it has a supplier number from the National Supplier Clearinghouse. DME MAC, or A/B MAC (B) as directed by the current DME jurisdiction list Non-implantable prosthetic devices Supplier. An ASC can be a supplier of non-implantable prosthetics if it has a supplier number from the National Supplier Clearinghouse. DME MAC, or A/B MAC (B), as directed by the current DME jurisdiction list Ambulance services Certified Ambulance supplier A/B MAC (B) Leg, arm, back and neck braces Supplier DME MAC, or A/B MAC (B), as directed by the current DME jurisdiction list Artificial legs, arms, and eyes Supplier DME MAC, or A/B MAC (B), as directed by the current DME jurisdiction list Services furnished by an independent laboratory Certified lab. ASCs can receive lab certification and a CLIA number. A/B MAC (B) Facility services for surgical procedures excluded from the ASC list ASC ASC bills beneficiary for facility charges associated with the non- covered procedure Examples of payment and billing for items or services that are included in payment for ASC facility services beginning January 1, 2008 Items included in payment for ASC facility services beginning January 1, 2008 Who may receive payment beginning January 1, 2008 Submit bills to: Implantable DME and accessories without OPPS pass-through status ASC A/B MAC (B) Implantable nonpass-through prosthetic devices (except NTIOLs), and accessories without OPPS pass-through status ASC A/B MAC (B) Radiology services for which there is no separate OPPS payment ASC A/B MAC (B) Drugs and biologicals for which there is no separate OPPS payment ASC A/B MAC (B)