Ambulatory Surgery Center Billing and Claims
ASC Fundamentals
ASCs bill under the ASC payment system, which uses payment indicators and groupers. Know the difference between facility and professional billing, and how device-intensive procedures and pass-through items are handled.
Concepts You Must Know
- ASC-covered procedures and the list of covered surgical services.
- Payment indicators and how they determine whether a service is payable in the ASC.
- Coinsurance and deductible application.
- Claims edits and the role of the remittance advice.
- Bundled services included in the ASC facility fee.
Traps
- Billing a professional service on the facility claim.
- Assuming every CPT code is ASC-payable; payment indicators control.
- Missing device-intensive or pass-through designations.
- Confusing hospital outpatient (OPPS) rules with ASC rules.
Rule of Thumb
Before billing, ask: Is this procedure on the ASC covered list, what is its payment indicator, and is it facility or professional? All three must align.
Worked Example
A procedure is performed in an ASC by the surgeon. The ASC bills the facility fee using the ASC payment indicator; the surgeon bills the professional service separately. The two claims must not duplicate the same component.