CMS Pub. 100-04, ch. 14, § 30.1

CMS performs the functions and calculations described above and publishes a list of

covered surgical procedures and covered ancillary services for which an ASC may be

paid each year, as well as quarterly updates via Medicare contractor instructions.

Regulations pertaining to Medicare rates for ASC facility services are contained in Part

416 of the Code of Federal Regulations, at http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title42/42tab_02.tpl

ASC services are subject to the usual Medicare Part B deductible and coinsurance

requirements. An exception to this is screening flexible sigmoidoscopies and screening

colonoscopies, regardless of the code that is billed for the establishment of a diagnosis as

a result of the test, or for the removal of tissue or other matter or other procedure, that is

furnished in connection with, as a result of, and in the same clinical encounter as the

colorectal cancer screening test. There is no deductible and the coinsurance will be

gradually reduced until it is completely waived for dates of service on or after January 1,

2030.

Prior to the revised ASC payment system implemented January 1, 2008, the ASC facility

payment rate was a standard overhead amount based on CMS’s estimate of a fair fee and

the costs incurred by the ASCs providing the procedures. HCPCS codes for procedures

covered in the ASC were compiled into 9 groups with a separate rate set for each group.

Beginning January 1, 2008, CMS updates payment rates and codes for covered surgical

procedures and covered ancillary services on a calendar year basis. Payable services are

updated on a quarterly basis. Also, CMS calculates and makes available to the claims

processing contractors CBSA-specific wage-adjusted payment rates for each of the ASC

payable codes to which geographic adjustment applies. The complete lists of ASC

covered surgical procedures and ASC covered ancillary services, the applicable payment

indicators, payment rates for each covered surgical procedure and ancillary service before

adjustments for regional wage variations, and wage indices are available on the CMS

Web-site at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/ASCPayment/11_Addenda_Updates.html and available to contractors on the

CMS mainframe.