Medicare Payments: ASC List Exclusion Criteria

Medicare pays for surgical procedures in an ASC unless the Centers for Medicare & Medicaid Services (CMS) determine that the procedures meet any of the following criteria for exclusion:

• Is on the inpatient only list

• Poses a significant safety risk to the beneficiary

• Typically requires active medical monitoring and care past midnight

• Directly involves major blood vessels

• Requires major or prolonged invasion of body cavities

• Generally results in extensive blood loss

• Is emergent in nature

• Is life-threatening in nature

• Commonly requires systemic thrombolytic therapy

• Can only be reported using an unlisted surgical procedures code