Page 247 - Medicare Benefit Policy Manual

services listed are not subject to bundling but, because they are excluded from the
statutory definition of inpatient hospital services, may be covered only under Part B.

Payment may be made under Part B to a hospital (or critical access hospital) for certain
medical and other health services furnished to its inpatients as provided in Chapter 6, §10
of this manual, “Medical and Other Health Services Furnished to Inpatients of
Participating Hospitals.”

Payment may be made under Part B for certain medical and other health services if the
beneficiary is an inpatient of a skilled nursing facility (SNF) as provided in chapter 8, §§
70ff of this manual.

260 - Ambulatory Surgical Center Services

(Rev. 77; Issued: 08-29-07; Effective: 01-01-08; Implementation: 01-07-08)

Facility services furnished by ambulatory surgical centers (ASCs) in connection with
certain surgical procedures are covered under Part B. To receive coverage of and
payment for its services under this provision, a facility must be certified as meeting the
requirements for an ASC and enter into a written agreement with CMS. Medicare
periodically updates the list of covered procedures and related payment amounts through
release of regulations and change requests. The ASC must accept Medicare’s payment
for such procedures as payment in full with respect to those services defined as ASC
facility services.

Where services are performed in an ASC, the physician and others who perform covered
services may also be paid for his/her professional services; however, the “professional”
rate is then adjusted since the ASC incurs the facility costs.

260.1 - Definition of Ambulatory Surgical Center (ASC)
(Rev. 104; Issued: 03-13-09; Effective Date: 04-01-09; Implementation Date: 04-
06-09)

An ASC for purposes of this benefit is a distinct entity that operates exclusively for the
purpose of furnishing outpatient surgical services to patients. It enters into an agreement
with CMS to do so. An ASC is either independent (i.e., not a part of a provider of
services or any other facility), or operated by a hospital (i.e., under the common
ownership, licensure, or control of a hospital). To be covered as an ASC operated by a
hospital, a facility elects to do so, and continues to be so covered unless CMS determines
there is good cause to do otherwise. This provision is intended to prohibit such an entity
from switching from one payment method to another to maximize its revenues (47 FR
34082, 34099, Aug. 5, 1982). For other general conditions and requirements, see 42 CFR
416.25-416.49. If the hospital based surgery center is certified as an ASC it is considered
an ASC and is subject to rules for ASCs. Related survey requirements are published in
the State Operations Manual, Pub. 100-07, Appendix L. Claims processing and payment
requirements for ASCs are published in Pub. 100-04, the Medicare Claims Processing
Manual, chapter 14.