Medicare Payment Resources

The Centers for Medicare & Medicaid Services (CMS) uses a network of contractors called Medicare Administrative Contractors (MACs) to process Medicare claims, enroll healthcare providers in the Medicare program and educate providers on Medicare billing requirements. MACs also handle claims appeals and answer beneficiary and provider inquiries. Find your MAC.

In 2008, CMS implemented a substantially revised payment system for ASCs based on Medicare’s hospital outpatient department payment system. Under the revised system, Medicare pays ASCs a prospectively determined rate for covered procedures (see background information on what is covered). These rates are updated annually.

Each summer Medicare proposes rates for the next year and then finalizes the rates in the fall.

2020 Final Payment Rule

Medicare's 2020 Final ASC Payment Rule

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.

2020 Final Rule Rate Calculator

This calculator shows your final national and local payment rates for 2020. Simply find your state and county from the drop-down menus at the top and the calculator does the rest.

Note: The calculator has been modified slightly from previous years. Rather than two separate tabs for payment rates with and without the sequester, you can now apply the sequester reduction via a drop-down menu at the top.

2020 Final Rule Payment Resources

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.

2020 Final Rule Analysis

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

Medicare's 2020 Proposed ASC Payment Rule

The Centers for Medicare & Medicaid Services (CMS) released the 2020 proposed payment rule for ASCs and hospital outpatient departments (HOPDs).

2020 Proposed Rule Rate Calculator

This calculator shows your proposed national and local payment rates for 2020. Simply find your state and county from the drop-down menus at the top and the calculator does the rest.

2020 Proposed Rule Q & A with Bill Prentice

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.

2020 Proposed Rule Payment Resources

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.

2020 Proposed Rule Analysis

This document identifies and briefly summarizes provisions of greatest interest to ASCA in the 2020 Medicare OPPS/ASC Payment System Proposed Rule.

2020 Proposed Rule Template Letters

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

Medicare's 2019 Final ASC 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.

2019 Final Rule Correction Notice

This notice, issued by CMS on December 21, 2018, corrects technical and typographical errors in the CY 2019 Hospital Outpatient Prospective Payments 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.

2019 Final Rule Rate Calculators

These calculators show your national and local payment rates for 2019. 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. Updated to reflect changes released in CMS payment addenda throughout the year.

CY 2019 ASCA Medicare Payment Documents

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.

2019 Final Rule Q & A with Bill Prentice

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 William Prentice talks about the policy changes the rule contains and the implications of those changes for ASCs.

2019 ASC Final Payment Rule – High-Volume Codes

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.


Analysis of 2019 ASC Final Rule versus ASCA Comments

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

Medicare's 2019 Proposed ASC Payment Rule

The Centers for Medicare & Medicaid Services (CMS) has released the 2019 proposed payment rule for ASCs and hospital outpatient departments (HOPDs).

Analysis of the Proposed Rule

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.

2019 Proposed Rule Rate Calculator

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 and type it into the calculator and the calculator does the rest.

 

2018 Final Payment Rule

Medicare's 2018 Final ASC 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.

2018 Final Rule Rate Calculator

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.

CY 2018 ASCA Documents

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

2018 ASC Final Payment Rule - High-Volume Codes

This document provides a comparison of the reimbursement rates in 2017 and 2018 for high-volume ASC codes.

Analysis of 2018 ASC Final Rule versus ASCA Comments

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

Medicare's 2018 Proposed ASC Payment Rule

The Centers for Medicare & Medicaid Services (CMS) has released the 2018 proposed payment rule for ASCs and hospital outpatient departments (HOPDs).

Analysis of the Proposed Rule

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.

2018 Proposed Rate Calculator

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.

2018 Proposed Medicare Payment Resources

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

Medicare's 2017 Final ASC 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.

2017 Final Rule Rate Calculator

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.

CY 2017 ASCA Documents

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; and
  • Ancillary.

2017 ASC Final Payment Rule - Top 100 Codes

This document provides a comparison of the reimbursement rates in 2016 and 2017 for the top 100 ASC codes by volume.

Analysis of 2017 OPPS - ASC Final Rule versus ASCA Comments

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.

Analysis of 2017 MPFS versus ASCA Comments

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

Medicare's 2017 Proposed ASC 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.

Analysis of the Proposed Rule

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.

Medicare's 2017 Proposed Physician Fee Schedule

This table identifies and briefly summarizes provisions in the 2017 MPFS Proposed Rule of particular interest to ASCA.

2017 Proposed Rate Calculator

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.

2017 Proposed Medicare Payment Resources Chart

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

Medicare's 2016 Proposed ASC 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.

Medicare's 2016 Proposed Physician Fee Schedule

This major proposed rule addresses changes to the physician fee schedule and other Medicare Part B payment policies.

Detailed Analysis of the Proposed Rule

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.

2016 Proposed Medicare Rate Calculator

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.

2016 Proposed 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.

 

2015 Final Payment Rule

Medicare's 2015 Final ASC 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.

ASCA's Analysis of the 2015 Final Payment Rule

2015 Final Rule Rate Calculator

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.

2015 Separately Payable Procedures

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.

2015 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.

2015 Ancillary Services

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.

2015 Device Intensive Procedures

This chart lists the procedures that CMS is classifying as device intensive in 2015 and their 2015 ASC payment rate.

2015 Office Based Procedures

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.

2015 Multiple-Procedure Discounting Exempt

This chart shows the procedures that are exempt from multiple-procedure discounting in 2015 and their 2015 ASC payment rate.

2015 Patient Cost Sharing Waived Services

This chart shows the services for which the patient copayment and deductible will be waived for 2015.

2015 Newly Device-Intensive Procedures

This chart lists the procedures that CMS is newly classifying as device intensive in 2015 and their 2015 ASC payment rate.

2015 ASC List Changes

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

2014 Final Rule Rate Calculator

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.

2014 Separately Payable Procedures Codes

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.

2014 Packaged Codes

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.

2014 Ancillary Services

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.

2014 Device Intensive Procedures

This chart lists the procedures classified as device intensive in 2014 and their 2014 ASC payment rate.

2014 Office Based Procedures

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.

2014 Multiple-Procedure Discounting Exempt

This chart shows the procedures exempt from multiple-procedure discounting in 2014 and their 2014 ASC payment rate.

2014 Patient Cost Sharing Waived Services

This chart shows the services for which the patient copayment and deductible are waived for 2014.

2014 New Packaged Codes

This chart shows only the procedures that are newly packaged this year that were separately payable last year.

2014 ASC List Changes

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.

2014 ASC Rates Compared to HOPD Rates

This chart compares the 2014 ASC rates with the 2014 HOPD rates for the same surgical procedures.

Procedures Subject to CMS Device Adjustment Policy

This is the list of ASC Procedures to which the No Cost/Full Credit and Partial Credit Device Adjustment Policy Applies.



While there is no substitute for receiving a legal opinion regarding the specific facts in a particular case from qualified counsel that practice in this specialized area of law, the Federal Regulations section of ASCA’s website provides a starting point for understanding the federal rules impacting ASCs. For questions or more information, contact Kara Newbury.

 


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