Where to Obtain Current Rates and Lists of Covered Services

30.1 - Where to Obtain Current Rates and Lists of Covered Services (Rev. 11793; Issued:01-19-23; Effective: 02-21-23; Implementation: 02-21-23) CMS performs the functions and calculations described above and publishes a list of covered surgical procedures and covered ancillary services for which an ASC may be paid each year, as well as quarterly updates via Medicare contractor instructions. Regulations pertaining to Medicare rates for ASC facility services are contained in Part 416 of the Code of Federal Regulations, at http://www.ecfr.gov/cgi-bin/text- idx?tpl=/ecfrbrowse/Title42/42tab_02.tpl ASC services are subject to the usual Medicare Part B deductible and coinsurance requirements. An exception to this is screening flexible sigmoidoscopies and screening colonoscopies, regardless of the code that is billed for the establishment of a diagnosis as a result of the test, or for the removal of tissue or other matter or other procedure, that is furnished in connection with, as a result of, and in the same clinical encounter as the colorectal cancer screening test. There is no deductible and the coinsurance will be gradually reduced until it is completely waived for dates of service on or after January 1, 2030. Prior to the revised ASC payment system implemented January 1, 2008, the ASC facility payment rate was a standard overhead amount based on CMS’s estimate of a fair fee and the costs incurred by the ASCs providing the procedures. HCPCS codes for procedures covered in the ASC were compiled into 9 groups with a separate rate set for each group. Beginning January 1, 2008, CMS updates payment rates and codes for covered surgical procedures and covered ancillary services on a calendar year basis. Payable services are updated on a quarterly basis. Also, CMS calculates and makes available to the claims processing contractors CBSA-specific wage-adjusted payment rates for each of the ASC payable codes to which geographic adjustment applies. The complete lists of ASC covered surgical procedures and ASC covered ancillary services, the applicable payment indicators, payment rates for each covered surgical procedure and ancillary service before adjustments for regional wage variations, and wage indices are available on the CMS Web-site at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/ASCPayment/11_Addenda_Updates.html and available to contractors on the CMS mainframe.