Wiki CMS 2018 FACILITY (ASC) fee schedule

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mcalomeni

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Can anyone point me to exactly where I can find ALL of the CPT codes accepted by CMS/Medicare w/their associated 2018 fee schedule? I've tried searching for Facility Fee schedule, ASC fee schedule, Facility ASC fee schedule, fee schedule and can't seem to find it. It's gotta be there, somewhere. Not looking for Physician/surgeon fee schedules (at the moment, though will come in handy, soon). Looking specifically for the Facility fee schedule (for an ASC) to bill for surgeries performed there. I'm finding the Medicare/CMS website very difficult to navigate.

Any help would be appreciated...

Mark...
 
Thanks Thomas. I spoke to Noridian and they pointed me to an ASC CMS fee schedule on their site and there seem to be differences between the two. I assume you're familiar w/Noridian. Example: CPT 66984 on the Noridian is $1370.33 and on this CMS site it was $991.95. Have you run into this? I'm wondering if one might be the Surgeon's rate ($991.95) and the other might be an ASC/Facility rate??
 
mcalomeni said:
Thanks Thomas. I spoke to Noridian and they pointed me to an ASC CMS fee schedule on their site and there seem to be differences between the two. I assume you're familiar w/Noridian. Example: CPT 66984 on the Noridian is $1370.33 and on this CMS site it was $991.95. Have you run into this? I'm wondering if one might be the Surgeon's rate ($991.95) and the other might be an ASC/Facility rate??
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I'm not familiar with the fee schedule that Noridian publishes, but the OPPS rates are adjusted based on the wage index for the geographic location of the facility. My guess is that Noridian has already made the adjustments to the rates in order to make the fee schedule specific to your locality. The CMS file shows just the unadjusted rates before applying the wage index. Most likely if you see that same ratio between the two schedules throughout all the procedures, then you can figure the wage index for your area. You can also look up the wage index for an area in the 2018 ASC final rule here:

https://www.cms.gov/Medicare/Medica...=1&DLEntries=10&DLSort=2&DLSortDir=descending

I've mainly worked with Outpatient Hospital OPPS, which is similar but not exactly the same methodology as ASC payment. Here's another document that you might find helpful - it goes into payment rates on page 5. I see that it says they apply the wage index factor of 50 percent, which would mean that the 50% of the fee schedule amount would be adjusted up or down based on the facility's wage index, if it works the same way as the hospital formula.

https://www.cms.gov/Outreach-and-Ed...s/downloads/AmbSurgCtrFeepymtfctsht508-09.pdf
 
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Thomas,

I am new to ASC billing.
So if there is an ASC fees schedule for Wisconsin Medicare...is that the entire charge? I "heard" that the fee schedule is the pc and tc components added up?
 
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