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Ambulatory Surgical Center (ASC) Services

1-864350211 - Monday, April 1, 2013

Rationale for the Referral: Medicare pays ASCs only for “procedures specified by the Secretary and published in the Federal Register that are separately paid under the OPPS.” 42 C.F.R. § 416.166(b). Codes used to identify unlisted procedures are not on the list of ASC covered procedures. In addition, regulations specifically exclude from payment to an ASC services that “can only be reported using a CPT unlisted surgical procedure code.” 42 C.F.R. § 416.166(c)(7).

Referral Document

Appeals Council Decision

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