ASC Medicare Payment System

Under Medicare's payment system ASCs are paid a facility fee intended to cover the costs associated with providing a surgical procedure. However, in general, ASCs are only paid a portion of what HOPDs receive for the exact same services. For a detailed overview of the payment system click here.

2009 Proposed ASC Payments Policies and Rates

On July 3, 2008, Medicare released its proposed changes to payment policies and rates for 2009. In general, ASCs will continue to be paid in much the same way as they are currently. The proposal adds 6 procedures to the ASC list of payable procedures and the proposal does not delete any procedures.

The proposed 2009 rates differ from the 2008 rates. Under the proposed changes, reimbursement for 92 procedures would decrease, while reimbursement for 2,475 procedures would increase. A detailed analysis of the proposed rate changes is available from the ASC Association — order yours today!

How will my ASC be impacted by Medicare's 2009 Rates? Click here to register for a special members-only web conference.

The ASC Association needs your help! The ASC Association will submit comments on Medicare's proposed 2009 payment policies and rates and we would like to hear from you about the impact the proposed changes will have on your center. In particular, we would like to hear about procedures that were not added to the ASC list that you think should be.

Please email your suggestions to asc@ascassociation.org as soon as possible, and be sure to include complete contact information so that we can follow up.

2009 Proposed Payment Policies and Rates Resources

• 2009 Proposed Medicare Payment Rule Download a copy of Medicare's proposed 2009 payment rule.
• Order a copy of the ASC Association's 2009 Medicare Rate Analysis This publication compares by specialty and at the CPT code level proposed payments for ASCs to current reimbursement and to hospital outpatient department reimbursement for the same procedure.
• 2009 Proposed Medicare Rate Calculator Calculate your proposed local payment rates! This calculator allows you to insert your proposed ASC wage index for 2009 and see the national payment rates, local payment rates, amount Medicare pays and the beneficiary copayment amounts for each procedure proposed to be payable effective January 1, 2009.
• 2009 Proposed ASC List of Payable Procedures This document contains the proposed list of payable procedures effective January 1, 2009, and corresponding national payment rate.
• 2009 Proposed ASC List Additions This file includes information about the 6 procedures proposed to be added in 2009 - CPT code, a short description and national payment rate.
• 2009 Proposed Device Intensive Procedures This chart lists the procedures proposed to be device intensive in 2009 and the proposed 2009 ASC payment rate. The chart also includes whether or not they are proposed to be device intensive for the first time.
• 2009 Proposed Office Based Procedures This chart lists the procedures proposed to be classified as office based in 2009, the proposed 2009 payments and whether the rates are based on the hospital outpatient department weights or on the physician's practice expense portion.
• 2009 Proposed Ancillary Services Rates This chart includes the list of proposed covered ancillary services integral to covered surgical procedures for 2009 including ancillary services for which payment is packaged. A short description of the service and the proposed payment rate is also included.
• 2009 Proposed Procedures Not Subject to Multiple Procedures Discount This document includes the list of procedures proposed to be exempt from multiple-procedure discounting.
• 2009 ASC List Procedures with No Payment Rate Due to Bundling This chart lists the procedures that are on the proposed 2009 ASC list, but for which there is no separate payment because they are packaged with other procedures.
• Medicare's Press Release on the Proposed 2009 ASC Payments Download a press release from Medicare on the proposed 2009 ASC payments.
• Medicare's Fact Sheet on the Proposed 2009 ASC Payments Download a fact sheet from Medicare on the the proposed 2009 ASC payments.

2008 Medicare Payment Policies and Rates

In November 2007, Medicare finalized its payment policies and rates for 2008. For 2008, ASCs are reimbursed for 3,393 surgical procedures at a rate of 65% of what HOPDs receive for the same procedures.

Under Medicare's payment system ASCs are paid a facility fee intended to cover the costs associated with providing a surgical procedure. However, in general, ASCs are only paid a portion of what HOPDs receive for the exact same services.

2008 Medicare Payment Policies and Rates Resources

• 2008 Final Medicare Payment Rule
• 2008 Medicare Rate Calculator
• 2008 ASC List of Payable Procedures
• 2008 ASC List Additions
• 2008 ASC List Deletions
• 2008 Device Intensive Procedures
• 2008 Office Based Procedures
• 2008 Ancillary Services Rates
• 2008 Procedures Not Subject to Multiple Procedures Discount
• 2008 ASC List Procedures with No Payment Rate Due to Bundling
• April 2008 Update to Ancillary Services