CMS Pub. 100-04, ch. 14, § 10.4

or Covered Ancillary Services

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

Physicians’ Services - This category includes most covered services performed in ASCs

that are not considered ASC services. Physicians who furnish services in ASCs may bill

for and receive separate payment under Part B. Physicians’ services include the services

of anesthesiologists administering or supervising the administration of anesthesia to

beneficiaries in ASCs and the beneficiaries’ recovery from the anesthesia. The term

physicians’ services also includes any routine pre- or post- operative services, such as

office visits, consultations, diagnostic tests, removal of stitches, changing of dressings,

and other services which the individual physician usually includes in the fee for a given

surgical procedure.

Implantable Durable Medical Equipment (DME) - If the ASC furnishes items of

implantable DME to patients, the ASC bills and receives a single payment from the local

contractor for the covered surgical procedure and the implantable device, as long as the

implantable device does not have pass-through status under the OPPS. When the surgical

procedure is not on the ASC list, the physician bills for his or her professional services

and the ASC may bill the beneficiary for the facility charges associated with the

procedure.

Non-implantable Durable Medical Equipment - If the ASC furnishes items of non-implantable DME to beneficiaries, it is treated as a DME supplier, and all the rules and

conditions ordinarily applicable to DME are applicable, including obtaining a supplier

number and billing the DME MAC where applicable.

Prosthetic Devices – Prior to January 1, 2008, an ASC was allowed to bill and receive

separate payment for implantable prosthetic devices, other than intraocular lenses (IOLs)

that were implanted, inserted, or otherwise applied by surgical procedures on the ASC list

of approved procedures. The ASC billed the A/B MAC (B) and received payment

according to the DMEPOS fee schedule. However, an intraocular lens (IOL) inserted

during or subsequent to cataract surgery in an ASC was included in the facility payment

rate.

Beginning January 1, 2008, payment for implantable prosthetic devices without OPPS

pass-through status is included in the ASC payment for the covered surgical procedure.

ASCs may not bill separately for implantable devices without OPPS pass-through status.

If the ASC furnishes non-implantable prosthetic devices to beneficiaries, the ASC is

treated as a supplier, and all the rules and conditions ordinarily applicable to suppliers are

applicable, including obtaining a supplier number and billing as directed by the

jurisdiction list.

Ambulance Services - If the ASC furnishes ambulance services, the facility may obtain

approval as an ambulance supplier to bill covered ambulance services.

Leg, Arm, Back and Neck Braces - These items of equipment, like non-implantable

prosthetic devices, are covered under Part B, but are not included in ASC payment for

ASC services. If the ASC furnishes these to beneficiaries, it is treated as a supplier, and

all the rules and conditions ordinarily applicable to suppliers are applicable, including

obtaining a supplier number and billing the DME MAC where applicable.

Artificial Legs, Arms and Eyes - Like non-implantable prosthetic devices and braces, this

equipment is not considered part of an ASC facility service and so is not included in ASC

payment for ASC services. If the ASC furnishes these items to beneficiaries, it is treated

as a supplier, and all the rules and conditions ordinarily applicable to suppliers are

applicable, including obtaining a supplier number and billing the DME MAC where

applicable.

Services of Independent Laboratory - As noted in §10.2, only a very limited number and

type of diagnostic tests are considered ASC facility services and these are included in the

ASC payment for covered surgical procedures. In most cases, diagnostic tests performed

directly by an ASC are not considered ASC facility services and are not covered under

Medicare. Section 1861(s) of the Act limits coverage of diagnostic lab tests in facilities

other than physicians’ offices, rural health clinics, or hospitals to facilities that meet the

statutory definition of an independent laboratory. In order to bill for diagnostic tests as a

laboratory, an ASC’s laboratory must be CLIA certified and enrolled with the A/B MAC

(B) as a laboratory and the certified clinical laboratory must bill for the services provided

to the beneficiary in the ASC. Otherwise, the ASC makes arrangements with a covered

laboratory or laboratories for laboratory services, as provided in 42 CFR 416.49.