CMS Pub. 100-04, ch. 14, § 20.2

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 procedures that are described by Level II HCPCS, Category I CPT codes, or Category

III CPT codes that directly crosswalk to or are clinically similar to the Category I CPT

codes in the surgical range that we have determined do not pose a significant safety risk,

would not expect to require an overnight stay when performed in an ASC, and are

separately paid under the OPPS.

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

separately paid under the OPPS, have been determined to pose no significant safety risk

to Medicare beneficiaries when furnished in ASCs, and for which standard medical

practice dictated that the beneficiary would not typically be expected to require active

medical monitoring and care at midnight following the procedure (overnight stay).

Additionally, covered surgical procedures do not include those surgical procedures

that: (1) generally result in extensive blood loss; (2) require major or prolonged

invasion of body cavities; (3) directly involve major blood vessels; (4) are

generally emergent or life threatening in nature; (5) commonly require systemic

thrombolytic therapy; (6) are designated as requiring inpatient care under

§ 419.22(n); (7) can only be reported using a CPT unlisted surgical procedure

code; or (8) are otherwise excluded under § 411.15.

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

outpatient prospective payment system are deemed to pose significant safety risk to

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

surgical procedures. Procedures that can only be reported by using an unlisted Category I

CPT code are excluded from consideration because there are no specifically descriptive

codes that can be evaluated for safety risk.