Do You Qualify for Noncovered Services Facility Payment?

Professional services your physicians performed in an ambulatory surgical center (ASC) on or after Jan. 1 may qualify for payment at the facility rate, according to the Centers for Medicare & Medicaid Services (CMS).

For noncovered professional services your physicians performed in a Medicare-approved ASC , enter place of service (POS) code 24 on claims to receive payment at the facility rate, according to CMS.

Ambulatory Surgical Center CASCC

Enter POS code 12 to receive payment at the nonfacility rate for physician services furnished in a patient’s home; and POS codes 49 or 99 for services provided in a facility other than a hospital, skilled nursing facility, community mental health center, or ASC.

Physician services performed in an ASC qualified for payment at the facility rate include anesthesiology administration and supervision and routine pre- or postoperative services, such as office visits, consultations, diagnostic tests, removal of stitches, and dressing changes.

For complete details, read CMS transmittal 1604, CR 6052, released Sept. 26.

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