CMS Pub. 100-04, ch. 12, § 90.3

(ASC)

(Rev. 1604, Issued: 09-26-08, Effective: 01-08-08, Implementation: 01-05-09)

See Chapter 14, for a description of services that may be billed by an ASC and services

separately billed by physicians.

The ASC payment does not include the professional services of the physician. These are billed

separately by the physician. Physicians’ services include the services of anesthesiologists

administering or supervising the administration of anesthesia to ASC patients and the patients’

recovery from the anesthesia. The term physicians’ services also includes any routine pre- or

postoperative services, such as office visits, consultations, diagnostic tests, removal of stitches,

changing of dressings, and other services which the individual physician usually performs.

The physician must enter the place of service code (POS) 24 on the claim to show that the

procedure was performed in an ASC.

The A/B MAC (B) pays the facility fee from the MPFSDB to the physician. The facility fee is

for services done in a facility other than the physician’s office and is typically less than the

nonfacility fee for services performed in the physician’s office.