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Ambulatory Surgical Center (ASC) Payment

ASC Drugs and Biologicals with Quarterly Change Request Restated Payment Rates

Some drugs and biologicals based on ASP methodology may have payment rates that are corrected retroactively. These retroactive corrections typically occur on a quarterly basis as a part of the ASC payment system quarterly update change request. Beginning with the January 2015 ASC payment system quarterly update change request, the list of drugs and biologicals with corrected payments rates, for a particular quarter, are accessible from the left menu link titled “Change Request Restated Drug and Biological Payment Rates”.

Spotlight:

The CY2015 OPPS/ASC Final Rule (CMS-1613-FC) including related links to the CY2015 ASC Payment Rate addenda and wage index files are available on the CMS website at: http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices.html .

Value Based Purchasing Program for Ambulatory Surgical Centers

The Affordable Care Act requires the Secretary of Health and Human Services to develop a plan to implement a value-based purchasing (VBP) program for payments under the Medicare program for ambulatory surgical centers (ASCs). The Secretary shall submit the report containing this plan to Congress.

The Report to Congress describes the current efforts to improve quality and payment efficiency in ASCs.  In addition, it considers the steps required in designing and implementing an ASC VBP program for payments under the Medicare program.  CMS views VBP as an important step forward in revamping how Medicare pays for health care services; moving the program towards rewarding better value, outcomes, and innovations, instead of merely volume.

The ASC VBP Report to Congress was authorized under Section 3006(f) of the Patient Protection and Affordable Care Act (Pub. L. 111-148), enacted on March 23, 2010, as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152), enacted on March 30, 2010 (collectively known as the Affordable Care Act) (as added by section 10301(a) of the Affordable Care Act).

See the Report to Congress in the Downloads section below.

Ambulatory Surgical Center (ASC) Approved HCPCS Codes and Payment Rates

These files contain the procedure codes which may be performed in an ASC under the Medicare program as well as the ASC payment group assigned to each of the procedure codes. The ASC payment group determines the amount that Medicare pays for facility services furnished in connection with a covered procedure.  For 2000 - 2006 files, go to the ASC Payment Rates Archive page (see the Left column).
Note: These files contain material copyrighted by the American Medical Association.

ASC CENTER

For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) ambulatory surgical centers, go to the Ambulatory Surgical Centers (ASC) Center (see under "Related Links Inside CMS" below).