ASC fee schedule payment update

October 2010 Update of the Ambulatory Surgical Center (ASC) Payment System

EFFECTIVE DATE: October 1, 2010
IMPLEMENTATION DATE: October 4, 2010

 GENERAL INFORMATION -  Background:

This Recurring Update Notification describes changes to, and billing instructions for, payment policies implemented in the October 2010 ASC payment system update. Final policy under the revised ASC payment system, as set forth in Medicare Program; Revised Payment System Policies for Services Furnished in Ambulatory Surgical Centers (ASCs), beginning in CY 2008 (72 FR 42470), requires that ASC payment rates for covered separately payable drugs and biologicals be consistent with the payment rates under the Medicare hospital outpatient prospective payment system (OPPS). Those rates are updated quarterly. Therefore, beginning with Transmittal 1488 (CR5994), issued April 9, 2008, CMS has issued quarterly updates to ASC payment rates for separately paid drugs and biologicals. CMS also updates the lists of covered surgical procedures and covered ancillary services to include newly created HCPCS codes, as appropriate. This instruction provides information on one newly created pass-through device HCPCS codes, five newly created drug HCPCS codes, and six newly created HCPCS codes describing imaging services that will be added to the ASC list of covered ancillary services effective October 1, 2010.

In this Change Request, we are issuing instructions to contractors to modify their systems to accept the October 2010 ASC Fee Schedule (ASCFS), the October 2010 ASC Payment Indicator (PI) file, the October 2010 ASC DRUG file, an updated April 2010 ASC DRUG file, and updated July 2010 ASC DRUG file, and to ensure that the updated files properly interface with all other ASC module programming. The October 2010 ASCFS is an updated file only. The October 2010 ASC PI file is an updated file only and will contain all PI updates impacted by this CR. All of the ASC DRUG files are full replacement files that include payment rates for all separately payable drugs and biologicals applicable to the calendar quarter. Additionally, we will also be providing contractors with a special new June 3, 2010 ASCFS to implement a recent NCD.