BC Advantage - 2018 Issue 11
Pricing for ASCs and APCs
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Article Overview
This article explains how Medicare-related pricing tools and payment indicators are used to review ambulatory surgical center and ambulatory payment classification information. It is intended for coders, billing staff, and revenue cycle teams who need to understand where to look for coverage, payment status, and fee schedule information in Find-A-Code and related Medicare resources.
Why This Topic Matters
Understanding these pricing resources helps users research payment-related code attributes, locate applicable fee schedule tools, and better interpret Medicare indicator data without relying on manual review alone.
Article Sections
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ASCs
Introduces ambulatory surgical center concepts and general Medicare payment context. Also discusses where to find ASC-related resources and pricing tools.
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ASC Payment Calculator
Describes the calculator tools used to estimate ASC pricing and references the use of related code lookup features for payment-oriented searches.
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ASC Payment Indicator (PI) Codes
Explains the role of ASC payment indicators in payment processing and notes that indicator data can change over time.
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APCs
Covers ambulatory payment classifications and the relationship between APC information, fee schedule data, and related pricing tools.
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APC Packager/Pricer
Briefly introduces a tool used to estimate APC-related payment details using claim-level information.
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Medicare Physician Fee Schedule (MPFS) Indicators
Reviews Medicare physician fee schedule indicator information associated with a sample procedure entry and summarizes the types of payment-related fields shown on the code page.
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List-A-Code
Describes a code-listing tool for filtering and exporting codes by criteria, including payment and status indicators.
What You Will Learn
- How ASC and APC pricing resources are organized
- Where to look for Medicare payment indicators and fee schedule tools
- How code-listing tools can be used to filter payment-related criteria
- What types of payment fields are displayed in the code-level indicator view
- How pricing support tools relate to ambulatory and outpatient coding workflows
Who Should Read This
- Medical coders
- Billing specialists
- Revenue cycle staff
- ASC facility staff
- Outpatient payment analysts
Codes Discussed
Modifiers Discussed
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