For Medicare purposes, an ASC is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission.
This definition applies to the ASC no matter who the payor is for the ASC’s services.
Additionally, services to Medicare patients are not expected to require active medical monitoring at midnight on the day of the procedure when furnished in an ASC.
You must be certified as meeting the requirements for an ASC and enter into an agreement with the Centers for Medicare & Medicaid Services (CMS) to be eligible for Medicare payment. An ASC can be either:
Independent (not part of a provider of services or any other facility)
Operated by a hospital (under the common ownership, licensure, or control of a hospital), in which case it must:
Be a separately identifiable entity separately certified and enrolled in Medicare with a supplier approval and agreement that is distinct from the hospital's Medicare provider agreement
Be physically, administratively, and financially independent and distinct from other operations of the hospital
Treat costs for the ASC as a non-reimbursable cost center on the hospital's cost report
Agree to the same assignment, coverage, and payment rules applied to independent ASCs
Comply with the conditions for coverage for ASCs
An ASC operated by a hospital is not the same as a provider-based outpatient surgery department of a hospital. A provider-based outpatient department of a hospital, including an outpatient surgery department:
May be on- or off-campus
Must be an integral part of the hospital, subject to the hospital conditions of participation
Is not separately enrolled and certified in Medicare or subject to ASC conditions for coverage