Page 253 - Medicare Benefit Policy Manual

Ambulance Services

If the ASC furnishes ambulance services, they are covered as ambulance services
pursuant to the terms and conditions of the Medicare Benefit Policy Manual, Chapter 10,
“Ambulance Services,” §§10. The facility may obtain approval as an ambulance supplier
to bill covered ambulance services.

Leg, Arm, Back, and Neck Braces

These items of equipment, like prosthetic devices, are covered under Part B, but are not
included in the ASC facility payment amount. Coverage of these items is described in
§130. If the ASC furnishes these to beneficiaries, it 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.

Artificial Legs, Arms, and Eyes

Like prosthetic devices and braces, this equipment is not considered part of an ASC
facility service and so is not included in the ASC facility payment rate. Information
regarding the coverage of these items is set out in §130. If the ASC furnishes these items
to beneficiaries, it 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.

Services of Independent Laboratory

As noted in §260.2, only a very limited number and type of diagnostic tests are
considered ASC facility services and included in the ASC facility payment rate. In most
cases, diagnostic tests performed directly by an ASC are not considered ASC facility
services and are not covered under Medicare. Section 1861(s) of the Act limits coverage
of diagnostic lab tests in facilities other than physicians’ offices, rural health clinics, or
hospitals to facilities that meet the statutory definition of an independent laboratory. (See
§§80.1 for a description of independent laboratories and covered services.) In order to
bill for diagnostic tests as a laboratory, an ASC’s laboratory must be CLIA certified and
enrolled with the contactor as a laboratory and the certified clinical laboratory must bill
for the services provided to the beneficiary in the ASC. Otherwise, the ASC makes
arrangements with a covered laboratory or laboratories for laboratory services, as
provided in 42 CFR 416.49. If the ASC has a certified independent laboratory, the
laboratory itself bills the A/B MAC (B), pursuant to §§80.

260.5 - List of Covered Ambulatory Surgical Center Procedures
(Rev. 77; Issued: 08-29-07; Effective: 01-01-08; Implementation: 01-07-08)

The law ties coverage of ambulatory surgical center (ASC) services under Part B to
specified surgical procedures, which are contained in a list revised and published