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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 health care providers in the Medicare program and educate providers on Medicare billing requirements. MACs also handle claims appeals and answer beneficiary and provider inquiries. Click here to 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 (for background information on what is covered, click here). These rates are updated annually.

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

2016 Final Payment Rule

Medicare's 2016 Final ASC Payment Rule
ASCs will see an effective update of 0.3%, while HOPDs will see an effective update of -0.3%. Read ASCA's initial analysis.

Detailed Analysis of the Final ASC Rule
This table summarizes select proposals from the 2016 Final ASC Payment Rule and explains their potential impact on ASCs.

Detailed Analysis of the Final Physician Fee Schedule
This table summarizes select proposals from the 2016 Final Physician Fee Schedule and explains their potential impact on ASCs.

2016 Final Medicare Payment Resources

Since not all documents were updated for the second quarter, please continue to use the other 2016 resources, including the Rate Calculator, which saw no code changes.

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

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.

ASCA's Analysis of the 2015 Final Payment Rule

 

2015 Final Medicare Payment Resources

2015 Medicare 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 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 Payment Rule
In 2014, ASCs will see an effective update of 1.2% while hospital outpatient departments (HOPDs) will see an effective update of 1.7%. CMS also finalized three of the four new quality measures that were in the proposed rule.

ASCA's Analysis of the 2014 Final Payment Rule

 


2014 Final Medicare Payment Resources

2014 Medicare 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.

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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 at knewbury@ascassociation.org.


Click on the heading tabs below to find out more information.

2013 Final Payment Rule

2013 Medicare Rate Calculator
This calculator shows your national and local payment rates for 2013. 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.

2013 ASC Rates Compared to HOPD Rates
This chart compares the 2013 ASC rates with the 2013 HOPD rates for the same surgical procedures.

2013 Separately Payable Procedures
This document provides the list of procedures that are payable in an ASC in 2013 and for which there is a separate payment made. The CPT code and the 2013 national ASC rate are provided. This list does not include packaged procedures.

2013 Packaged Procedures
This chart lists the procedures that are on the 2013 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.

2013 Ancillary Services
This chart provides the list of covered ancillary services for 2013. 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.

2013 Device Intensive Procedures
This chart lists the procedures classified as device intensive in 2013 and their 2013 ASC payment rate.

2013 Office Based Procedures
This chart lists the procedures classified as office based for 2013, their 2013 payment rates, and whether the rates are based on the hospital outpatient department rates or on the physician's practice expense rates.

2013 Multiple-Procedure Discounting Exempt
This chart shows the procedures exempt from multiple-procedure discounting in 2013 and their 2013 ASC payment rate.

2013 Patient Cost Sharing Waived Services
This chart shows the services for which the patient copayment and deductible are waived for 2013.

2013 ASC List Changes
This chart lists codes that have been added to and deleted from the ASC list of payable procedures and the reason for addition/deletion.

2012 Final Payment Rule

2012 Final Medicare Rate Calculator
This calculator shows your local payment rates for 2012. 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 incorporating CMS's April 24, 2012 correction. Corrected rates are retroactive to January 1, 2012.

2012 Separately Payable Procedures
This document provides the list of procedures that are payable in an ASC in 2012 and for which there is a separate payment made. The CPT code and the 2012 national ASC rate are provided. This list does not include packaged procedures.

2012 Packaged Procedures
This chart lists the procedures that are on the 2012 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.

2012 Ancillary Services
This chart provides the list of covered ancillary services for 2012. 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.

2012 Device Intensive Procedures
This chart lists the procedures classified as device intensive in 2012 and their 2012 ASC payment rate.

2012 Office Based Procedures
This chart lists the procedures classified as office based for 2012, their proposed 2012 payment rates, and whether the rates are based on the hospital outpatient department rates or on the physician's practice expense rates.

2012 Multiple-Procedure Discounting Exempt
This document lists the procedures that are exempt from multiple-procedure discounting in 2012.

2012 Patient Cost Sharing Waived Services
This chart shows the services for which the patient copayment and deductible are waived for 2012.




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