Ambulatory surgical centers (ASC) billing tips
How to bill for ASC facility services
Verify the procedure to be performed is valid when provided by an ASC by reviewing the appropriate CMS Addendums and payment indicators.
- Place of service 24 is used for ASC claims.
- ASC providers are required to always accept assignment.
- The ASC facility NPI number is reported in item 33a or the EDI equivalent.
- Note: An NPI is not required in Item 24j or the EDI equivalent.
- ASC Modifiers FB, FC, LT, PA, PB, PC, RT, TC, 52, 73 and 74 can be reported on the ASC claims.
- Modifier 26 is used by physicians only and not ASCs.
- ASC providers don't report modifier 50 for bilateral procedures:
- When more than one surgical procedure is performed in the same operative session, multiple surgery rules apply:
Medicare will allow 100% of the highest paying surgical procedure on the claim plus 50% for the other ASC-covered surgical procedures furnished in the same session. - Bilateral procedures should be reported:
Single unit on two separate lines or a single unit on one line with "2" in the unit field, for both procedures to be paid correctly.
Multiple procedure reduction of 50% will apply to all bilateral procedures subject to multiple procedure discounting.
- When more than one surgical procedure is performed in the same operative session, multiple surgery rules apply:
References