Page 250 - Medicare Benefit Policy Manual

included in their facility charges. To the extent that such simple tests are included in the
ASC’s facility charges, they are considered facility services. However, under the
Medicare program, diagnostic tests are not covered in laboratories independent of a
physician’s office, rural health clinic, or hospital unless the laboratories meet the
regulatory requirements for the conditions for coverage of services of independent
laboratories. (See 42 CFR 416.49.) Therefore, diagnostic tests performed by the ASC
other than those generally included in the facility’s charge are not covered under Part B
as such and are not billed to the A/B MAC (B) as diagnostic tests. If the ASC has its
laboratory certified as meeting the regulatory conditions, then the laboratory itself bills
the A/B MAC (B) (or the beneficiary) for the tests performed.

The ASC may make arrangements with an independent laboratory or other laboratory,
such as a hospital laboratory, to perform diagnostic tests it requires prior to surgery. In
general, however, the necessary laboratory tests are done outside the ASC prior to
scheduling of surgery, since the test results often determine whether the beneficiary
should even have the surgery done on an outpatient basis in the first place.

Administrative, Recordkeeping, and Housekeeping Items and Services

These include the general administrative functions necessary to run the facility e.g.,
scheduling, cleaning, utilities, and rent.

Blood, Blood Plasma, Platelets, etc., Except Those to Which Blood Deductible
Applies

While covered procedures are limited to those not expected to result in extensive loss of
blood, in some cases, blood or blood products are required. Usually the blood deductible
results in no expenses for blood or blood products being included under this provision.
However, where there is a need for blood or blood products beyond the deductible, they
are considered ASC facility services and no separate charge is permitted to the
beneficiary or the program.

Materials for Anesthesia

These include the anesthetic itself, and any materials, whether disposable or reusable,
necessary for its administration.

Intraocular Lenses (IOLs)

Effective for services furnished on or after March 12, 1990, ASC facility services include
intraocular lenses approved by the Food and Drug Administration (FDA) for insertion
during or subsequent to cataract surgery.

FDA has classified IOLs into the following four categories, any of which are included:

Anterior chamber angle fixation lenses;