Page 249 - Medicare Benefit Policy Manual

These include all services in connection with covered procedures furnished by nurses and
technical personnel who are employees of the ASC. In addition to the nursing staff, this
category includes orderlies, technical personnel, and others involved in patient care;

Use by the Patient of the ASC’s Facilities

This category includes operating and recovery rooms, patient preparation areas, waiting
rooms, and other areas used by the patient or offered for use by the patient’s relatives in
connection with surgical services; and

Drugs, Biologicals, Surgical Dressings, Supplies, Splints, Casts, Appliances, and
Equipment

This category includes all supplies and equipment commonly furnished by the ASC in
connection with surgical procedures. See below for certain exceptions. Drugs and
biologicals are limited to those that cannot be self-administered. (See §60.)

Coverage policy for surgical dressings is similar to that followed under Part B. Under
Part B, coverage for surgical dressings is limited to primary dressings; i.e., therapeutic
and protective coverings applied directly to lesions on the skin or on openings to the skin
required as the result of surgical procedures. (Items such as Ace bandages, elastic
stockings and support hose, Spence boots and other foot coverings, leotards, knee
supports, surgical leggings, gauntlets, and pressure garments for the arms and hands are
generally used as secondary coverings and therefore are not covered as surgical
dressings.) Surgical dressings usually are applied first by a physician and are covered as
“incident to” a physician’s service in a physician’s office setting. In the ASC setting,
such dressings are included in the facility’s services.

However, others may reapply surgical dressings later, including the patient or a member
of the patient’s family. When the patient on a physician’s order obtains surgical
dressings from a supplier, e.g., a drugstore, the surgical dressing is covered under Part B.
The same policy applies in the case of dressings obtained by the patient on a physician’s
order following surgery in an ASC; the dressings are covered and paid as a Part B service
by the local A/B MAC (B), included in the definition of facility services.

Similarly, “other supplies, splints, and casts” include only those furnished by the ASC at
the time of the surgery. Additional covered supplies and materials furnished later are
generally furnished as “incident to” a physician’s service, not as an ASC facility service.
The term “supplies” includes those required for both the patient and ASC personnel, e.g.,
gowns, masks, drapes, hoses, and scalpels, whether disposable or reusable.

Diagnostic or Therapeutic Items and Services

These are items and services furnished by ASC staff in connection with covered surgical
procedures. With respect to diagnostic tests, many ASCs perform simple tests just before
surgery, primarily urinalysis and blood hemoglobin or hematocrit, which are generally