Medicare pays for surgical procedures in an ASC unless the Centers for Medicare & Medicaid Services (CMS) determine that the procedures meet any of these criteria for exclusion.
The facility fee is designed to pay for the use of the ASC, including:
- Technician and related services
- Diagnostic or therapeutic services or items directly related to the provision of a surgical procedure
- Administrative, recordkeeping and housekeeping items and services
- The operating surgeon’s supervision of the services provided by an anesthetist
As a general rule, the facility fee also covers:
- The drugs
- Surgical dressings
- Appliances and equipment that are directly related to the provision of surgical procedures
- Anesthesia materials and implants, including intraocular lenses (IOLs)
Medicare does, however, make a separate payment for certain drugs, including:
- Some anesthetic agents
- Radiologic services
These separately payable items and services are considered ancillary services, and Medicare pays ASCs for them when they are provided in conjunction with a Medicare-covered procedure.
In addition, Medicare makes an additional payment for interocular lenses (IOLs) that have been designated as “New Technology” IOLs (NTIOLs). Currently, no IOLs are classified as NTIOLs. CMS, however, may designate certain IOLs as being NTIOLs in the future.