CMS Pub. 100-04, ch. 14, § 10.3

or Covered Ancillary Services

(Rev. 11793; Issued:01-19-23; Effective: 02-21-23; Implementation: 02-21-23)

A single payment is made to an ASC for facility services furnished by the ASC in

connection with a covered surgical procedure. Additional payments may be made to the

ASC for covered ancillary services, specifically brachytherapy sources, certain

implantable devices with pass-through status under the OPPS, corneal tissue acquisition,

drugs and biologicals for which separate payment is allowed under the OPPS, radiology

services for which separate payment is allowed under the OPPS, and certain other

integral services not included in the primary procedure payment. To be covered ancillary

services for which separate payment is made, these items and services must be provided

integral to covered surgical procedures, that is, immediately before, during, or

immediately after the covered surgical procedure.

However, a number of items and services covered under Medicare may be furnished in an

ASC that are not considered ASC services, and which payment for ASC services does not

include. These non-ASC services are covered and paid for under the applicable

provisions of Part B. In addition, the ASC may be part of a medical complex that

includes other entities, such as an independent laboratory, supplier of durable medical

equipment, or a physician’s office, which are covered as separate entities under Part B.

In general, an item or service provided in a separate part of the complex is not considered

an ASC service, except as defined above.

Examples of payment and billing for items or services that are not ASC services:

Items not included in

payment for ASC services

Who may receive payment Submit bills to:

Physicians’ services

(including surgical

procedures excluded from

ASC payment)

Physician A/B MAC (B)

The purchase or rental of

non-implantable durable

medical equipment (DME)

to ASC patients for use in

their homes

Supplier- An ASC can be a

supplier of DME if it has a

supplier number from the

National Supplier

Clearinghouse.

DME MAC, or A/B

MAC (B) as directed by

the current DME

jurisdiction list

Non-implantable prosthetic

devices

Supplier. An ASC can be a

supplier of non-implantable

prosthetics if it has a supplier

number from the National

Supplier Clearinghouse.

DME MAC, or A/B

MAC (B), as directed

by the current DME

jurisdiction list

Ambulance services Certified Ambulance supplier A/B MAC (B)

Leg, arm, back and neck

braces

Supplier DME MAC, or A/B

MAC (B), as directed

by the current DME

jurisdiction list

Artificial legs, arms, and

eyes

Supplier DME MAC, or A/B

MAC (B), as directed

by the current DME

jurisdiction list

Services furnished by an

independent laboratory

Certified lab. ASCs can

receive lab certification and a

CLIA number.

A/B MAC (B)

Facility services for surgical

procedures excluded from

the ASC list

ASC ASC bills beneficiary

for facility charges

associated with the non-covered procedure

Examples of payment and billing for items or services that are included in payment for

ASC facility services beginning January 1, 2008

Items included in payment for ASC facility

services beginning January 1, 2008

Who may receive

payment beginning

January 1, 2008

Submit bills

to:

Implantable DME and accessories without

OPPS pass-through status

ASC A/B MAC

(B)

Implantable nonpass-through prosthetic

devices (except NTIOLs), and accessories

without OPPS pass-through status

ASC A/B MAC

(B)

Radiology services for which there is no

separate OPPS payment

ASC A/B MAC

(B)

Drugs and biologicals for which there is no

separate OPPS payment

ASC A/B MAC

(B)