CMS Adjustment of Surgery Center Payment for Multiple Procedures Performed During the Same Operative Session

The following Q&A comes from the Centers for Medicare & Medicaid Services website.

Q: Will CMS adjust ambulatory surgical center payment for multiple procedures performed during the same operative session under the revised ASC payment system?

CMS: When the ASC performs multiple surgical procedures in the same operative session that are subject to the multiple procedure discount, contractors pay 100 percent of the highest paying surgical procedures on the claim, plus 50 percent of the applicable wage adjusted payment rate(s) for the other ASC covered surgical procedures subject to the multiple procedure discount that are furnished in the same session. In determining the ranking of procedures for application of the multiple procedure reduction, contractors shall use the lower of the billed charge or the ASC payment amount. The multiple procedure reduction is the last pricing routine applied to applicable ASC procedure codes.

ASC surgical procedures billed with modifier -73 or -52 shall not be subjected to further pricing reductions (i.e., the multiple procedure price reduction rules will not apply). The hospital outpatient prospective payment system (OPPS)/ASC final rule for the relevant payment year specifies whether or not a surgical procedure is subject to multiple procedure discounting for that year. For more information, see the Medicare Claims Processing Manual, Chapter 14, Section 40.5.

Source: CMS

Read more ASC billing and coding guidance:

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