decisionhealth Newsletters, Coder Pink Sheets - 2010 Issue 4 (April)
Ask the Expert: Surgeon’s fee in an ASC when code is not on ASC list
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Article Overview
This premium article addresses Medicare payment policy for surgeon reimbursement in an ambulatory surgery center setting when the procedure is not included on the ASC-covered surgical code list. It is relevant to coders, billers, and reimbursement staff who need to understand how ASC coverage status affects physician payment methodology and why the policy changed beginning in 2008. The discussion references CMS guidance and related official resources.
Why This Topic Matters
Payment methodology in an ASC can affect surgeon reimbursement and facility billing expectations. Understanding the applicable Medicare policy helps coding and reimbursement teams avoid incorrect assumptions about facility versus non-facility payment in this setting.
What You Will Learn
- How Medicare ASC payment policy affects physician reimbursement in a facility setting
- Why coverage status on the ASC surgical code list matters for payment methodology
- What policy change CMS noted beginning in 2008
- Where to find official CMS resources related to ASC payment policy
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice managers
- Reimbursement specialists
- Compliance staff
Codes Discussed
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