Wiki Facility -v- Non-Facility G2 ASC Indicator

[susie59]

Good Afternoon,

I need help understanding why a CPT code has a G2 ASC Payment Indicator attached to it (not an office based procedure) also list a non-facility payment? If the CPT code can not be used in an office setting, why does Medicare then attached a fee to it as if it can be billed in an office setting?

For example, CPT code 22523 has the G2, but also list a Non-Facility Fee of $7,9994.04, and a Facility fee of $566.14.

Thank you in advance for any help that you can offer.

Susie

 

[susie59]

Also, I had called Medicare and questioned this and the representative stated that an ASC is not considered a "facility", only in-patient surgery centers are considered "facilities"; therefore, a free standing ASC would not be considered a facility. Has anyone else ever heard this?

 

[nsteinhauser]

On the 'Physician Fee Schedule,' the non-facility lisitings (work RVU, PE RVU, Malpractice, etc.) are for professional charges and the facility listings are for facility charges. It sounds like the person you spoke with was confused. The G2 listing doesn't indicate that procedure has to be done in the inpatient setting. Hope this helps.