Ambulatory Surgery Center

AMBULATORY SURGICAL CENTER PAYMENT SYSTEM (MLN Booklet, March 2020)

ASC DEFINITION: An ASC is a distinct entity that operates exclusively to furnish outpatient surgical services to patients who do not require hospitalization, and are typically discharged less than 24 hours following admission. Medicare ASC patients should not need active medical monitoring at midnight on the day of the procedure.

PAYMENT: ASCs get a single Medicare payment for covered surgical procedures, including ASC facility services furnished with the covered procedure. Examples of covered ASC facility services are:

• Nursing services, technical personnel furnished services, and other related services
• Drugs and biologicals (when Medicare makes no Outpatient Prospective Payment System [OPPS] separate payment), surgical dressings, supplies, splints, casts, appliances, and equipment
• Administrative, recordkeeping, and housekeeping items and services
• Blood, blood plasma, and platelets, except when the blood deductible applies
• Materials, including supplies and equipment for administering and monitoring anesthesia
• Intraocular lenses
• Implantable devices, except devices with OPPS pass-through status
• OPPS-packaged radiology services