2024 Proposed ASC Payment Rule
The Centers for Medicare & Medicaid Services (CMS) released the 2024 proposed payment rule for ASCs and hospital outpatient departments (HOPD).
This calculator shows your proposed national and local payment rates for 2024. Simply select your state and county from the dropdown menus at the top and the calculator does the rest.
NOTE: The calculator is set to show rates by default with the mandatory 2 percent payment cut known as the sequester.
This document identifies and briefly summarizes provisions of greatest interest to ASCA in Medicare's 2024 OPPS/ASC Payment System proposed rule.
This document includes separate worksheets for each of the following code groups:
- Separately Payable
- Packaged
- Office-Based
- Device-Intensive
- Multiple Procedure Discounting Exempt
- Cost-Sharing Waived
- Ancillary
- Surgical Codes Payable in HOPDs but not ASCs
- Inpatient-Only Surgical Codes
Please note, this document includes only national rates.
See this page for customizable letters that your facility can use to provide feedback to CMS on the CY 2024 proposed payment rule. The following templates are available:
- Procedure List Letter: A template letter that can be used to request specific codes for addition to the ASC Covered Procedures List. The letter should include volume and outcomes data, if possible.
- ASC Weight Scalar Letter: A template letter requesting changes that CMS eliminate the ASC weight scalar, a secondary rate decrease that suppresses ASC Medicare reimbursement rates relative to hospital outpatient departments.
- Total Shoulder Arthroplasty Letter: A template letter requesting that total shoulder arthroplasty (CPT 23472) be added to the ASC Covered Procedures List.
- ASC-20 Letter: A template letter requesting that CMS remove ASC-20: COVID-19 Vaccination Coverage Among HCP from the ASC Quality Reporting Program.
The page also contains sample language that can be incorporated into comments if you would rather not submit a formal letter, or want to mix and match issues. The most persuasive comments will also include individual details regarding how the proposed changes will impact your center.
2023 Final ASC Payment Rule
The Centers for Medicare & Medicaid Services (CMS) released the 2023 final payment rule for ASCs and hospital outpatient departments (HOPD).
This document identifies and briefly summarizes provisions of greatest interest to ASCA in the CY 2023 OPPS/ASC final payment rule.
Use this page for all 2023 rate calculators. Rate calculators, updated for each quarter, show national and local payment rates. Simply select your state and county from the dropdown menus at the top and the calculator does the rest.
These workbooks, posted quarterly, include separate worksheets for each of the following code groups:
- Separately Payable
- Packaged
- Office-Based
- Device-Intensive
- Multiple Procedure Discounting Exempt
- Cost-Sharing Waived
- Ancillary
- Surgical Codes Payable in HOPDs but not ASCs
- Inpatient-Only Surgical Codes
This spreadsheet compares 2023 ASC rates with HOPD rates for the all separately payable procedures.
This spreadsheet breaks down codes eligible for the new complexity adjustment policy. Beginning in 2023, Medicare will provide a “complexity adjustment” for certain code combinations, creating 55 new C codes that better reflect the true cost of performing select add-on procedures in conjunction with certain primary procedures.
This spreadsheet breaks down all codes designated as device intensive in 2023. The final column shows the difference between the 2023 proposed and final rates.
This spreadsheet helps you find your local wage index adjustment and calculate the local rate for any Medicare procedure.
2023 Proposed ASC Payment Rule
The Centers for Medicare & Medicaid Services (CMS) released the 2023 proposed payment rule for ASCs and hospital outpatient departments (HOPD).
This calculator shows your proposed national and local payment rates for 2023. Simply select your state and county from the dropdown menus at the top and the calculator does the rest.
NOTE: The calculator is set to show rates by default with the mandatory 2 percent payment cut known as the sequester.
These formal comments were submitted by ASCA in response to the CY 2023 OPPS/ASC proposed rule.
This document identifies and briefly summarizes provisions of greatest interest to ASCA in Medicare's 2023 OPPS/ASC Payment System proposed rule.
See this page for customizable letters that your facility can use to provide feedback to CMS on the CY 2023 proposed payment rule. The following templates are available:
- Procedure List Letter: A template letter requesting that CMS allow for a certain code or codes to be performed on Medicare beneficiaries in ASCs.
- ASC-11 Letter: A template letter requesting that CMS remove ASC-11 (Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery) from the ASC Quality Reporting Program (ASCQR) beginning in 2023.
- ASC Weight Scalar Letter: A template letter requesting changes that CMS eliminate the ASC weight scalar, a secondary rate decrease that suppresses ASC Medicare reimbursement rates relative to hospital outpatient departments.
The page also contains sample language that can be incorporated into comments if you would rather not submit a formal letter, or want to mix and match issues. The most persuasive comments will also include individual details regarding how the proposed changes will impact your center.
2022 Final ASC Payment Rule
The Centers for Medicare & Medicaid Services (CMS) released the 2022 final payment rule for ASCs and hospital outpatient departments (HOPD).
This document identifies and briefly summarizes provisions of greatest interest to ASCA in the CY 2022 Medicare OPPS/ASC Payment System Final Rule.
Use this page for all 2022 rate calculators. Rate calculators, updated for each quarter, show national and local payment rates. Simply select your state and county from the dropdown menus at the top and the calculator does the rest.
This document includes separate worksheets for each of the following code groups:
- Separately Payable
- Packaged
- Office-Based
- Device-Intensive
- Multiple Procedure Discounting Exempt
- Cost-Sharing Waived
- Ancillary
- Surgical Codes Payable in HOPDs but not ASCs
- Inpatient-Only Surgical Codes
Please note, this document includes only national rates.
2022 Proposed ASC Payment Rule
The Centers for Medicare & Medicaid Services (CMS) released the 2022 proposed payment rule for ASCs and hospital outpatient departments (HOPD).
This calculator shows your proposed national and local payment rates for 2022. Simply select your state and county from the dropdown menus at the top and the calculator does the rest.
NOTE: The calculator is set to show rates by default with the mandatory 2 percent payment cut known as the sequester. Please read the file description for more information.
These formal comments were submitted by ASCA in response to the CY 2022 OPPS/ASC proposed rule.
This document identifies and briefly summarizes provisions of greatest interest to ASCA in Medicare's 2022 OPPS/ASC Payment System proposed rule.
This document includes separate worksheets for each of the following code groups:
- 2022 device-intensive codes (including 95 new device-intensive codes)
- Codes proposed for removal from the ASC Covered Procedures List (ASC-CPL) due to reversal of a 2021 policy change
- Codes proposed for addition back to the inpatient-only (IPO) list due to reversal of a 2021 policy change
ASCA will return to the usual payment resources spreadsheet that breaks out code groups such as separately payable, device-intensive, etc., for the final rule.
See this page for customizable letters that your facility can use to provide feedback to CMS on the CY 2022 proposed payment rule. The following templates are available:
- Procedure List Letter: A template letter requesting that CMS continue payment for any of the 258 codes proposed for removal from the ASC-CPL.
- ASC-11 Letter: A template letter requesting that CMS stop the addition of ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery to the ASC Quality Reporting (ASCQR) Program beginning in 2023.
- OAS CAHPS Letter: A template letter requesting changes to the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) proposed to be mandatory for ASCs beginning in 2024.
The most persuasive comments will also include individual details regarding how the proposed changes will impact your center.
2021 Final ASC Payment Rule
The Centers for Medicare & Medicaid Services (CMS) released the 2021 final payment rule for ASCs and hospital outpatient departments (HOPD).
Use this page for all 2021 rate calculators. Rate calculators, updated for each quarter, show national and local payment rates. Simply select your state and county from the dropdown menus at the top and the calculator does the rest.
This document includes separate worksheets for each of the following code groups:
- 267 new codes added to the ASC Covered Procedures List (ASC-CPL) for 2021
- Separately Payable
- Packaged
- Office-Based
- Device-Intensive
- Multiple Procedure Discounting Exempt
- Cost-Sharing Waived
- Ancillary
- Surgical Codes Payable in HOPDs but not ASCs
- Inpatient-Only Surgical Codes
Please note, this document includes only national rates. For local rates please use the Medicare Rate Calculator.
This calculator shows 2021 national and local HOPD payment rates as published in CMS' Addendum B. This is intended as a resource for ASCs that are converting or thinking of converting to billing as hospitals temporarily as part CMS' Hospitals Without Walls initiative to fight the COVID-19 pandemic. Any specific billing questions should be directed to your contracted billing expert.
This document identifies and briefly summarizes provisions of greatest interest to ASCA in the CY 2021 Medicare OPPS/ASC Payment System Final Rule.
2021 Proposed ASC Payment Rule
The Centers for Medicare & Medicaid Services (CMS) released the 2021 proposed payment rule for ASCs and hospital outpatient departments (HOPD).
This calculator shows your proposed national and local payment rates for 2021. Simply select your state and county from the dropdown menus at the top and the calculator does the rest.
This document identifies and briefly summarizes provisions of greatest interest to ASCA in the 2021 Medicare OPPS/ASC Payment System Proposed Rule. It also provides ASCA's position as submitted via formal comments.
This document includes separate worksheets for each of the following code groups:
- Codes proposed for normal addition to the ASC Covered Procedures List (ASC-CPL) in 2021
- Codes that will be payable if CMS finalizes Alternative #2 for reforming the ASC-CPL
- Codes proposed for removal from the Inpatient-Only (IPO) List in the first year of a three-year transitional period after which the IPO would be eliminated
ASCA will return to the usual payment resources spreadsheet that breaks out code groups such as separately payable, device-intensive, etc., for the final rule.
See this page for customizable letters that your facility can use to provide feedback to CMS on the CY 2021 proposed payment rule. The following templates are available:
- Secondary Rescaling Letter: A sample letter requesting that CMS remove the secondary rescaling that is applied to ASC payments, a policy which discourages volume migration to the ASC setting.
- Total Hip Arthroplasty Letter: A sample letter encouraging CMS to finalize its proposal to add total hip arthroplasty to the ASC Covered Procedures List (CPL).
- Procedure List Letter: A general template letter requesting that codes be added to the ASC CPL.
The page also contains sample language that can be incorporated into comments if you would rather not submit a formal letter, or want to mix and match issues. The most persuasive comments will also include individual details regarding how the proposed changes will impact your center.
2020 Final Payment Rule
Note: Under normal circumstances, an across-the-board 2 percent reduction in payments known as sequestration would apply to Medicare's ASC rates. However, Section 3709 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act temporarily suspends the 2 percent payment reduction for all claims with dates of service from May 1 through December 31, 2020.
The Centers for Medicare & Medicaid Services (CMS) released the 2020 final payment rule for ASCs and hospital outpatient departments (HOPDs). According to the rule, ASCs will get an effective update of 2.6 percent.
Visit this page to find all CY 2020 Rate Calculators, including updated versions as CMS releases new addenda. Simply select your state and county from the dropdown menus at the top and the calculator does the rest.
This document includes separate worksheets for each of the following code groups:
- Separately Payable
- Packaged
- Office-Based
- Multiple Procedure Discounting Exempt
- Device-Intensive
- Cost-Sharing Waived
- Ancillary
- Surgical Codes Payable in HOPDs but not ASCs
- Inpatient-Only Surgical Codes
Please note, this document includes only national rates. For local rates please use the Medicare Rate Calculator.
This document identifies and briefly summarizes provisions of greatest interest to ASCA in the CY 2020 Medicare OPPS/ASC Payment System Final Rule.
2020 Proposed Payment Rule
The Centers for Medicare & Medicaid Services (CMS) released the 2020 proposed payment rule for ASCs and hospital outpatient departments (HOPDs).
This calculator shows your proposed national and local payment rates for 2020. Simply select your state and county from the dropdown menus at the top and the calculator does the rest.
On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) released its proposed 2020 payment rule for ASCs and hospital outpatient departments (HOPDs). ASCA Chief Executive Officer Bill Prentice talks about the proposed changes the rule contains and the implications of those changes for ASCs.
This document includes separate worksheets for each of the following code groups:
- Separately Payable
- Packaged
- Office-Based
- Multiple Procedure Discounting Exempt
- Device-Intensive
- Cost-Sharing Waived
- Ancillary
- Surgical Codes Payable in HOPDs but not ASCs
- Inpatient-Only Surgical Codes
Please note, these documents include the national rates. For your local rates, please use the Medicare rate calculator.
This document identifies and briefly summarizes provisions of greatest interest to ASCA in the 2020 Medicare OPPS/ASC Payment System Proposed Rule.
See this page for customizable letters that your facility can use to provide feedback to CMS on the CY 2020 proposed payment rule. The following templates are available:
- Total Knee Arthroplasty (TKA) Letter: A sample comment letter to encourage CMS to finalize its proposal to add TKA to the ASC-payable list.
- Cardiology Code Letter: A sample comment letter to encourage CMS to finalize its proposal regarding the addition of new cardiology codes to the ASC-payable list.
- Procedure List Letter: A general template letter requesting that codes be added to the ASC-payable list.
- Secondary Rescaling Letter: A sample letter requesting that CMS remove the secondary rescaling that is applied to ASC payments.
The page also contains sample language that can be incorporated into comments if you would rather not submit a formal letter, or want to mix and match issues. The most persuasive comments will also include individual details regarding how the proposed changes will impact your center.
2019 Final Payment Rule
The Centers for Medicare & Medicaid Services (CMS) released the 2019 final payment rule for ASCs and hospital outpatient departments (HOPDs). According to the rule, ASCs will get an effective update of 2.1 percent, while HOPDs will get an effective update of 1.35 percent.
This notice, issued by CMS on December 21, 2018, corrects technical and typographical errors in the CY 2019 Hospital Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center Payment System Final Rule (see above). In the notice, CMS corrects an error related to multiple procedure discounting, and makes changes to a number of other payment indicators.
These calculators show your national and local payment rates for 2019. Simply look up your local wage index from the easy-to-use chart, type it into the calculator and the calculator does the rest. Updated to reflect changes released in CMS payment addenda throughout the year.
This document includes separate worksheets for each of the following code groups:
- Separately Payable
- Packaged
- Office-Based
- Multiple Procedure Discounting Exempt
- Device-Intensive
- Cost-Sharing Waived
- Ancillary
- Surgical Codes Payable in HOPDs but not ASCs (NEW for 2019!)
- Inpatient-Only Surgical Codes (NEW for 2019!)
Please note, these documents include the national rates. For your local rates, please use the Medicare Rate Calculator.
On November 2, 2018, the Centers for Medicare & Medicaid Services (CMS) released its final 2019 payment rule for ASCs and hospital outpatient departments (HOPD). ASCA Chief Executive Officer Bill Prentice talks about the policy changes the rule contains and the implications of those changes for ASCs.
This document provides a comparison between 2018 and 2019 final rates, as well as 2019 proposed to 2019 final rates for codes that have historically had high volume in the ASC setting.
This table discusses how CMS finalized those provisions on which ASCA submitted comments in the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System 2019 final rule.
2019 Proposed Payment Rule
The Centers for Medicare & Medicaid Services (CMS) has released the 2019 proposed payment rule for ASCs and hospital outpatient departments (HOPDs).
This table identifies and briefly summarizes provisions of greatest interest to ASCA in the 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS)/ASC Payment System Proposed Rule.
This calculator shows your proposed national and local payment rates for 2019. Simply look up your local wage index from the easy-to-use chart, type it into the calculator and the calculator does the rest.
2018 Final Payment Rule
The Centers for Medicare & Medicaid Services (CMS) has released the 2018 final payment rule for ASCs and hospital outpatient departments (HOPDs). According to the rule, ASCs would get an effective update of 1.2 percent, while HOPDs would get an effective update of 1.35 percent.
This calculator shows your national and local payment rates for 2018. Simply look up your local wage index from the easy-to-use chart and type it into the calculator and the calculator does the rest. Please make sure you are using the rate calculator that corresponds to the date of services provided; for instance, all cases performed on or after July 1, 2018, should use the Third Quarter 2018 Medicare Rate Calculator.
This document includes separate worksheets for each of the following code groups:
- Separately Payable
- Packaged
- Office-based
- Multiple Procedure Discounting Exempt
- Device Intensive
- Cost-Sharing Waived
- Ancillary
This document provides a comparison of the reimbursement rates in 2017 and 2018 for high-volume ASC codes.
This table discusses how CMS finalized those provisions on which ASCA submitted comments in the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System 2018 final rule.
2018 Proposed Payment Rule
The Centers for Medicare & Medicaid Services (CMS) has released the 2018 proposed payment rule for ASCs and hospital outpatient departments (HOPDs).
This table identifies and briefly summarizes provisions of greatest interest to ASCA in the 2018 Medicare Hospital Outpatient Prospective Payment System (OPPS)/ASC Payment System Proposed Rule.
This calculator shows your proposed national and local payment rates for 2018. Simply look up your local wage index from the easy to use chart and type it into the calculator and the calculator does the rest.
ASCA has combined all of the payment resources (other than the rate calculator) into one document. This allows members to search for any code that is on the ASC-payable list, and determine several pieces of information about each code.
This information includes:
- Information regarding changes to payment rates between the 2017 final and 2018 proposed rules;
- Payment indicators for each code;
- and Multiple procedure discount status for each code
The information found in this new resource includes national payment rates. For your local payment rate, please still utilize the rate calculator.
2017 Final Payment Rule
The Centers for Medicare & Medicaid Services (CMS) has released the 2017 final payment rule for ASCs and hospital outpatient departments (HOPDs). According to the rule, ASCs would get an effective update of 1.9 percent, while HOPDs would get an effective update of 1.65 percent.
This calculator shows your national and local payment rates. Please make sure you are using the rate calculator for the quarter during which services were provided. Simply look up your local wage index from the easy to use chart and type it into the calculator and the calculator does the rest.
This document includes separate worksheets for each of the following code groups:
- Separately Payable
- Packaged
- Office-based
- Multiple Procedure Discounting Exempt
- Device-Intensive
- Cost-Sharing Waived
- Ancillary
This document provides a comparison of the reimbursement rates in 2016 and 2017 for the top 100 ASC codes by volume.
This table discusses how CMS finalized those provisions on which ASCA submitted comments in the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rule.
This table discusses how CMS resolved those provisions on which ASCA submitted comments in the 2017 Medicare Physician Fee Schedule final rule.
2017 Proposed Payment Rule
The Centers for Medicare & Medicaid Services (CMS) has released the 2017 proposed payment rule for ASCs and hospital outpatient departments (HOPDs). According to the proposed rule, ASCs would get an effective update of 1.2 percent, while HOPDs would get an effective update of 1.55 percent.
This table identifies and briefly summarizes provisions of greatest interest to ASCA in the 2017 Medicare Hospital Outpatient Prospective Payment System (OPPS)/ASC Payment System Proposed Rule.
This table identifies and briefly summarizes provisions in the 2017 MPFS Proposed Rule of particular interest to ASCA.
This calculator shows your proposed national and local payment rates for 2017. Simply look up your local wage index from the easy to use chart and type it into the calculator and the calculator does the rest.
ASCA has combined all of the payment resources (other than the rate calculator) into one document. This allows members to search for any code that is on the ASC-payable list, and determine several pieces of information about each code.
This information includes:
- Information regarding changes to payment rates between the 2016 final and 2017 proposed rules;
- Payment indicators for each code; and
- Multiple procedure discount status for each code.
The information found in this new resource includes national payment rates. For your local payment rate, please still utilize the rate calculator.
2016 Final Payment Rule Resources
Since not all documents were updated for the third and fourth quarters, please continue to use the other 2016 resources that saw no code changes.
Fourth Quarter (Q4) 2016 Rate Documents
Fourth Quarter 2016 Final Medicare Payment Resources Chart
The ASCA Payment Resources Chart has been updated for fourth quarter of 2016.
Fourth Quarter 2016 Final Medicare Rate Calculator
The Medicare Rate Calculator has been updated slightly for the fourth quarter of 2016. It shows your national and local payment rates for this. Simply look up your local wage index from the easy to use chart and type it into the calculator and the calculator does the rest.
Fourth Quarter 2016 Separately Payable Procedures
This updated chart lists all surgical and ancillary codes for which a separate payment will be made in 2016. The CPT code and 2016 national ASC payment rate are provided. This list does not include deleted/discontinued codes or packaged procedures.
Fourth Quarter 2016 Ancillary Procedures
This updated chart provides the list of covered ancillary services for 2016. ASCs may bill for ancillary services when provided in conjunction with covered surgical procedures. This list does not include packaged services. This list is updated quarterly.
Third Quarter (Q3) 2016 Rate Documents
Third Quarter 2016 Final Medicare Payment Resources Chart
The ASCA Payment Resources Chart has been updated for third quarter of 2016.
Third Quarter 2016 Final Medicare Rate Calculator
The Medicare Rate Calculator has been updated slightly for the third quarter of 2016. It shows your national and local payment rates for this. Simply look up your local wage index from the easy to use chart and type it into the calculator and the calculator does the rest.
Third Quarter 2016 Separately Payable Procedures
This updated chart lists all surgical and ancillary codes for which a separate payment will be made in 2016. The CPT code and 2016 national ASC payment rate are provided. This list does not include deleted/discontinued codes or packaged procedures.
Third Quarter 2016 Ancillary Procedures
This updated chart provides the list of covered ancillary services for 2016. ASCs may bill for ancillary services when provided in conjunction with covered surgical procedures. This list does not include packaged services. This list is updated quarterly.
Second Quarter (Q2) 2016 Rate Documents
Second Quarter 2016 Final Medicare Payment Resources Chart
The ASCA Payment Resources Chart has been updated for Second Quarter of 2016.
2016 Packaged Codes (Based on April 2016 Addenda)
This chart shows the surgical and ancillary codes that will be packaged with other procedures for 2016 and thus receive no separate reimbursement.
2016 Cost-Sharing Waived Services (Based on April 2016 Addenda)
This chart shows the services for which the patient copayment and deductible will be waived for 2016.
2016 Ancillary Services (Based on April 2016 Addenda)
This chart provides the list of covered ancillary services for 2016. ASCs may bill for ancillary services when provided in conjunction with covered surgical procedures. This list does not include packaged services.
2016 Final Medicare Rate Calculator
This calculator shows your national and local payment rates for 2016. Simply look up your local wage index from the easy to use chart and type it into the calculator and the calculator does the rest.
2016 Final Medicare Payment Resources Chart
New this year, ASCA has combined all of the payment resources (other than the rate calculator) into one document. This allows members to search for any code that is on the ASC-payable list, and determine several pieces of information about each code. This information includes:
-
Information regarding changes to payment rates between the 2015 final and 2016 proposed rules;
-
Payment indicators for each code; and
-
Multiple procedure discount status for each code.
The information found in this new resource includes national payment rates. For your local payment rate, please still utilize the rate calculator.
2016 Separately Payable Procedures
This chart lists all surgical and ancillary codes for which a separate payment will be made in 2016. The CPT code and 2016 national ASC payment rate are provided. This list does not include deleted/discontinued codes or packaged procedures.
2016 Packaged Procedures
This chart shows the surgical and ancillary codes that will be packaged with other procedures for 2016 and thus receive no separate reimbursement.
2016 Ancillary Services
This chart provides the list of covered ancillary services for 2016. ASCs may bill for ancillary services when provided in conjunction with covered surgical procedures. This list does not include packaged services. This list is updated quarterly.
2016 Device Intensive Procedures
This chart lists the procedures that CMS is classifying as device intensive in 2016 and their 2016 ASC payment rate.
2016 Office Based Procedures
This chart lists the procedures that are classified as office based in 2016, the 2016 payment rates and whether these rates are based on the hospital outpatient department rates or on the physician's practice expense rate.
2016 Multiple-Procedure Discounting Exempt
This chart shows the procedures that are exempt from multiple-procedure discounting in 2016 and their 2016 ASC payment rate.
2016 Patient Cost Sharing Waived Services
This chart shows the services for which the patient copayment and deductible will be waived for 2016.
2016 Proposed Payment Rule
If the proposed rule were to be finalized as drafted, ASCs would see an effective update of 1.1%, while HOPDs would see an effective update of 1.9%. Read ASCA's initial analysis.
This major proposed rule addresses changes to the physician fee schedule and other Medicare Part B payment policies.
This table summarizes select proposals from the 2016 Proposed ASC Payment Rule and the 2016 Proposed Physician Fee Schedule and explains the potential impact of each proposal on ASCs.
This calculator shows your proposed national and local payment rates for 2016. Simply look up your local wage index from the easy to use chart and type it into the calculator and the calculator does the rest.
New this year, ASCA has combined all of the payment resources (other than the rate calculator) into one document. This allows members to search for any code that is on the ASC-payable list, and determine several pieces of information about each code. This information includes:
-
Information regarding changes to payment rates between the 2015 final and 2016 proposed rules;
-
Payment indicators for each code; and
-
Multiple procedure discount status for each code.
The information found in this new resource includes national payment rates. For your local payment rate, please still utilize the rate calculator.
2015 Final Payment Rule
In 2015, ASCs will see an effective update of 1.4% while hospital outpatient departments (HOPDs) will see an effective update of 2.2%. Other changes from the final rule include a comprehensive APC policy and an expansion of packaged codes.
This calculator shows your national and local payment rates for 2015. Simply look up your local wage index from the easy to use chart and type it into the calculator and the calculator does the rest.
This chart lists all surgical and ancillary codes for which a separate payment will be made in 2015. The CPT code and 2015 national ASC payment rate are provided. This list does not include deleted/discontinued codes or packaged procedures.
This chart shows the surgical and ancillary codes that will be packaged with other procedures for 2015 and thus receive no separate reimbursement.
This chart provides the list of covered ancillary services for 2015. ASCs may bill for ancillary services when provided in conjunction with covered surgical procedures. This list does not include packaged services.
This chart lists the procedures that CMS is classifying as device intensive in 2015 and their 2015 ASC payment rate.
This chart lists the procedures that are classified as office based in 2015, the 2015 payment rates and whether these rates are based on the hospital outpatient department rates or on the physician's practice expense rate.
This chart shows the procedures that are exempt from multiple-procedure discounting in 2015 and their 2015 ASC payment rate.
This chart shows the services for which the patient copayment and deductible will be waived for 2015.
This chart lists the procedures that CMS is newly classifying as device intensive in 2015 and their 2015 ASC payment rate.
This chart lists codes that have been added to and deleted from the ASC list of payable procedures for 2015 and the reason for addition/deletion.
2014 Final Payment Rule
This calculator shows your national and local payment rates for 2014. Simply look up your local wage index from the easy to use chart and type it into the calculator and the calculator does the rest.
This document provides the list of procedures that are payable in an ASC in 2014 and for which there is a separate payment made. The CPT code and the 2014 national ASC rate are provided. This list does not include packaged procedures.
This chart lists the procedures that are on the 2014 ASC list, but for which there are no separate payments because payments for these packaged procedures are included in the payments made for other procedures.
This chart provides the list of covered ancillary services for 2014. ASCs may bill for ancillary services when provided in conjunction with covered surgical procedures. This list will be updated quarterly to reflect changes made by Medicare.
This chart lists the procedures classified as device intensive in 2014 and their 2014 ASC payment rate.
This chart lists the procedures classified as office based for 2014, their 2014 payment rates, and whether the rates are based on the hospital outpatient department rates or on the physician's practice expense rates.
This chart shows the procedures exempt from multiple-procedure discounting in 2014 and their 2014 ASC payment rate.
This chart shows the services for which the patient copayment and deductible are waived for 2014.
This chart shows only the procedures that are newly packaged this year that were separately payable last year.
This chart lists codes that have been added to and deleted from the ASC list of payable procedures for 2014 and the reason for addition/deletion.
This chart compares the 2014 ASC rates with the 2014 HOPD rates for the same surgical procedures.
This is the list of ASC Procedures to which the No Cost/Full Credit and Partial Credit Device Adjustment Policy Applies.