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Revised ASC Payment System (2008)
ASC Payment Overview
MLN Matters
ASC Payment Summary Since 1982, Medicare has paid for certain surgical procedures when performed in freestanding or hospital-based ASCs. Starting January 1, 2008, CMS revised the payment system for ASC services. CMS used the OPPS relative payment weights as a basis for payment under the revised ASC payment system.
The payment policies for the revised ASC payment system expand the types of procedures that are eligible for Medicare payment when performed in the ASC setting, limit ASC payments for procedures that are performed predominantly in physicians’ offices to the amount that would be paid for the non-facility practice expense (PE) under the Medicare Physician Fee Schedule (MPFS), and allow for separate payment to ASCs for covered ancillary services that are provided integral to covered surgical procedures.
The revised ASC payment rates are approximately 65 percent of the value of the equivalent services and procedues under the OPPS.
A modified payment methodology is used to establish theASC payment rates for device-intensive procedures, defined as “ASC-covered surgical procedures” that, under the OPPS, are assigned to APCs for which the device cost is greater than 50 percent of the APC’s median cost. Payment for the high-cost devices is packaged into the associated procedure payments under the revised ASC system (as it is under the OPPS). Medicare pays the same amount for thedevice-related portionof the procedure cost under the revised ASC payment system as under the OPPS. However, payment for theservice portionof the ASC rate is about 65 percent of the corresponding OPPS service payment, just like the payment for other surgical procedures under the revised ASC payment system. The sum of the ASC device and service portions constitutes the complete ASC procedure payment. Devices are not paid separately.
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