Page 252 - Medicare Benefit Policy Manual

covered under Medicare is not considered an ASC service. Examples of services payable
in addition to ASC services are found in §260.4.

260.4 - Coverage of Services in ASCs, Which are Not ASC Services
(Rev. 77; Issued: 08-29-07; Effective: 01-01-08; Implementation: 01-07-08)

Physicians’ Services

This category includes most covered services performed in ASCs, which are not
considered ASC facility services. Physicians’ services were covered before coverage of
ASC services, and the ASC amendment did not change this. Consequently, physicians
who perform covered services in ASCs receive payment under the existing Part B system.
Physicians’ services include the services of anesthesiologists administering or
supervising the administration of anesthesia to beneficiaries in ASC’s and the
beneficiaries’ recovery from the anesthesia. The term physicians’ services also includes
any routine pre- or post-operative services, such as office visits, consultations, diagnostic
tests, removal of stitches, changing of dressings, and other services that the individual
physician usually includes in the fee for a given surgical procedure.. The contractor
applies the same criteria, limits and understandings to physicians’ services for procedures
furnished in the ASC that are applied to the procedures furnished by the same physicians
on an inpatient hospital basis.

The Sale, Lease, or Rental of Durable Medical Equipment (DME) to ASC Patients
for Use in Their Homes

Non-implantable Durable Medical Equipment (DME) - If the ASC furnishes items of
non-implantable DME to beneficiaries, it is treated as a DME supplier, and all the rules
and conditions ordinarily applicable to DME are applicable, including obtaining a
supplier number and billing the DME MAC where applicable.

Prosthetic Devices

Prosthetic devices, other than intraocular lenses (IOLs), whether implanted, inserted, or
otherwise applied by covered surgical procedures, are covered, but are not included in the
ASC facility payment amount. However, §4063(b) of P.L. 100-203 amended §1833
(i)(2)(A) of the Act to mandate that payment for an intraocular lens (IOL) inserted during
or subsequent to cataract surgery in an ASC be included in the facility payment rate.
This bundling of the payment for an IOL with the facility fee is effective for services
furnished on or after March 12, 1990. More information on coverage of prosthetic
devices may be found in §120. Further information on the coverage of IOLs may be
found in §260.2.

Non-Implantable Prosthetic Devices - If the ASC furnishes non-implantable prosthetic
devices to beneficiaries, the ASC is treated as a supplier, and all the rules and conditions
ordinarily applicable to suppliers are applicable, including obtaining a supplier number
and billing the DME MAC where applicable.