CMS Pub. 100-04, ch. 14, § 40.6

A ninth ASC payment group was established in a “Federal Register” notice (56 FR

67666) published December 31, 1991. The ninth payment group amount ($1,150) was

assigned to only one procedure, CPT code 50590, extracorporeal shock wave lithotripsy

(ESWL). However, a court order issued March 12, 1992, has stayed the Group 9

payment rate until the Secretary publishes all information relevant to the setting of the

ESWL rate, receives comments, and publishes a subsequent final notice. This has not yet

been completed.

CMS advised contractors to make payment to ASCs for ESWL services furnished after

January 29, 1992, and through the date when the ASC received notice from the contractor

of the court order staying the Group 9 payment rate. This was a temporary measure to

avoid penalizing ASCs that furnished ESWL services in accordance with the December

31, 1991, “Federal Register” notice and that could not have been expected to know that

the March 12, 1992, court order set aside the ESWL provisions of that notice.

Contractors did not make Medicare payment for ESWL as an ASC procedure when such

services were furnished after the date that the carrier advised an ASC of the court order.

However, contractors were instructed to retain all ASC claims for ESWL with a service

date after January 29, 1992, and before the date when they were notified about the court

order. It may be necessary to retrieve these clams for further action at some later date.

Beginning January 1, 2008, with the revised ASC payment system, contractors may pay

for any of the ESWL services that are included on the ASC list of covered surgical

procedures.