Ambulatory Surgical Center (ASC) payment
ASC payment is the Medicare prospective payment system that pays ambulatory surgical centers a set amount per covered procedure, tied to the same groups used for hospital outpatient services.
Updated
Ambulatory Surgical Center (ASC) payment is the Medicare prospective payment system that reimburses freestanding ambulatory surgical centers for surgical procedures furnished to Medicare beneficiaries. Each covered procedure is assigned to a payment group and paid a federal rate that is updated annually, rather than the facility billing its costs or charges.
ASC payment groups are aligned with the Hospital Outpatient Prospective Payment System's Ambulatory Payment Classifications (APCs): for many procedures, Medicare pays the ASC a set percentage of the corresponding OPPS rate. Whether a procedure is payable in the ASC setting — and at what rate — depends on whether CMS has added it to the ASC-covered list and on the current year's rulemaking.
In practice
Because ASC payment is a prospective per-procedure rate with its own covered-procedures list, billing the ASC facility side requires confirming the procedure is on the current ASC list and reporting it with the code that maps to the correct payment group. The physician side of the same procedure is billed and paid separately under the Physician Fee Schedule.
Commonly confused with
- Ambulatory Payment Classification (APC): An APC groups hospital outpatient services for OPPS payment; ASC payment uses aligned groups to pay ambulatory surgical centers. The two systems are related but pay different settings at different rates.
- Physician Fee Schedule: The Physician Fee Schedule pays the physician side of a surgical service; ASC payment pays the facility side. The same procedure generates both a facility ASC claim and a physician fee-schedule claim.