Questions CMS addresses included what ASC procedures and services are payable when under the revised ASC payment system; CMS responds:
Under the ASC payment system, Medicare will make facility payments to ASCs only for the specific ASC covered surgical procedures on the ASC list of covered surgical procedures published in Addendum AA of the OPPS/ASC final rule for the relevant payment year.
In addition, Medicare will make separate payment to ASCs for certain covered ancillary services that are provided integral to a covered ASC surgical procedure. Covered ancillary services include the following:
1. brachytherapy sources;
2. certain implantable items with pass-through status under the OPPS;
3. certain items and services that CMS designates as contractor-priced, including, but not limited to, the procurement of corneal tissue;
4. certain drugs and biologicals for which separate payment is allowed under the OPPS; and
5. certain radiology services for which separate payment is allowed under the OPPS.Other non-ASC services such as physician services and prosthetic devices may be covered and separately billed under Medicare Part B. See the Medicare Claims Processing Manual, Chapter 14, Section 10.2 for more information.
CMS also addresses how ASCs should report bilateral procedures under the ASC payment system:
Bilateral procedures should be reported as a single unit on two separate lines or with “2” in the units field on one line, in order for both procedures to be paid. While use of the -50 modifier is not specifically prohibited according to CMS billing instructions, the modifier will not be recognized for payment purposes and may result in incorrect payment to ASCs. The multiple procedure reduction of 50 percent will apply to all bilateral procedures subject to multiple procedure discounting. See the MLN Matters article SE0742 … for billing examples illustrating this revised payment policy.
Other questions CMS answered:
1. Whether CMS has changed the payment policy for new technology intraocular lenses (NTIOLs) under the revised ASC payment system, to which the agency responded that it has not (click here for the list of NTIOLs assigned to currently active categories)
2. How ASCs should report and charge brachytherapy sources under the revised ASC payment system. “ASCs must report the HCPCS codes and number of units for the brachytherapy sources acquired by the ASC and implanted in beneficiaries integral to covered surgical procedures,” says CMS.
3. If implanted brachytherapy sources qualify for the physician referral exception for implants furnished by an ASC; CMS indicated that they do.
4. How ASCs should bill for packaged implantable devices under the new system and how ASCs should bill for separately payable devices with passthrough status under the OPPS, to which CMS responded:
ASCs should not report separate line item HCPCS codes or charges for devices and other services or items that are packaged into payment for covered surgical procedures and therefore not paid separately.
ASCs will bill separately for devices that have pass-through status under the OPPS when provided integral to covered surgical procedures and will be paid separately under the revised ASC payment system. ASCs should use the appropriate Level II HCPCS codes to report the devices. Only two devices have pass-through status under the OPPS as of January 2008: C 182 1 (Interspinous process distraction device (implantable)) and L8690 (Auditory osseointegrated device, includes all internal and external components). For these two devices only, ASCs should report the code for the device and its charge. The Medicare contractor will determine the payment amount for each of the pass-through devices.
5. Whether radiology and other imaging services and outpatient prescription drugs provided in the ASC are subject to the physician self-referral law under the revised ASC payment system; CMS indicates they are not because the agency changed the definition of these services.
To download a PDF of the FAQ, click here.
