Ambulatory Surgical Center Physician billing: What is it and Why does it make a difference in the Place of Service code used?
The Centers for Medicare & Medicaid Services (CMS) defines an Ambulatory Surgical Center (ASC) as "a freestanding facility, other than a physician's office, where surgical and diagnostic services are provided on an ambulatory basis." The correct Place of Service (POS) Code to use is 24. Talk to the facility to determine whether you are providing your service in an ASC.
Medicare is publishing this information based on an audit the Office of the Inspector General (OIG) conducted nationwide on this issue. The audit results showed physician offices were billing using office as the place of service inappropriately. Please check your office records to verify you are using the correct POS code.
Physician's services are not part of the facility fee. Physician's services include anesthesia, Evaluation and Management services not included in the global surgery package, and diagnostic tests. These services are separately payable from the ASC facility fee. The correct POS code is 24. This is the correct POS code even if the service is not on the list of covered procedures. The physician does not incur practice expenses for services provided in this facility. The use of POS code 24 will make a difference in payment to the physicians for the services provided. Medicare will pay at a reduced fee for those services that have both a facility and non-facility payment on the Fee Schedule.
An ASC is a distinct entity that operates exclusively for the purpose of furnishing outpatient surgical services to patients. The entity enrolls with Medicare as an ASC facility and receives a facility provider number. The facility itself receives reimbursement from Medicare for covered surgical procedures. You can access a listing of the covered services at http://www.cms.hhs.gov/center/asc.asp 
. The Benefit Policy Manual, Chapter 15, Section 260 discusses what types of services are included in the ASC facility charge. You can access this at http://www.cms.hhs.gov/Manuals/IOM/itemdetail.asp?
filterType=none&filterByDID=-99&sortByDID=1
&sortOrder=ascending&itemID=CMS012673
&intNumPerPage=10 . From this screen you can scroll down to Chapter 15. Once in Chapter 15, you can scroll down to Section 260.2. WPS Medicare has a National Coverage Provision ASC-001 that discusses both the facility and physician billing.
Page Last Updated: Tuesday, 15-Jul-2008 10:44:57 CDT
