CMS Pub. 100-02, ch. 15, § 260.5.2

The listed procedures are all considered “surgical procedures” for coverage purposes

under the ASC provision, regardless of the specific use to which the procedure is put.

For example, many of the “oscopy” procedures listed - bronchoscopy, laryngoscopy, etc.,

may be employed for either diagnostic or therapeutic purposes, or both at the same time,

such as when the “oscopy” permits both detection and removal of a polyp. Those

procedures are considered “surgical procedures” within the context of the ASC provision.

Also, surgical procedures are commonly thought of as those involving an incision of

some type, whether done with a scalpel or (more recently) a laser, followed by removal

or repair of an organ or other tissue. In recent years, the development of fiber optics

technology, together with new surgical instruments utilizing that technology, has resulted

in surgical procedures that, while invasive and manipulative, do not require incisions.

Instead, the procedures are performed without an incision through various body openings.

Those procedures, some of which include the “oscopy” procedures mentioned above, are

also considered surgical procedures for purposes of the ASC provision, and several are

included in the list of covered procedures.

Beginning January 1, 2008, the ASC list of covered surgical procedures is comprised of

surgical procedures that CMS determines do not pose a significant safety risk and are not

expected to require an overnight stay following the surgical procedure.

Surgical procedures are defined as Category I CPT codes within the surgical range of

CPT codes, 10000 through 69999. Also considered to be included within that code range

are Level II HCPCS and Category III CPT codes that crosswalk to or are clinically

similar to the Category I CPT codes in the range.

The surgical codes that are included on the ASC list of covered surgical procedures are

those that have been determined to pose no significant safety risk to Medicare

beneficiaries when furnished in ASCs and that are not expected to require active medical

monitoring at midnight of the day on which the surgical procedure is performed

(overnight stay).

Procedures that are included on the inpatient list used under Medicare’s hospital

outpatient prospective payment system and procedures that can only be reported by using

an unlisted Category I CPT code are deemed to pose significant safety risk to

beneficiaries in ASCs and are not eligible for designation and coverage as covered

surgical procedures.