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Issue Number - Name
0088 - Ancillary Services Billed Without an Approved Surgical Procedure
Review Type
Automated
Claim Type
Ambulatory Surgery Center
Region and State
RAC 1-4
All States
Date Approved
2018-02-13

Description

Select covered ancillary items and services are not payable if there is no approved ambulatory surgery center (ASC) surgical procedure on the same claim or in history for the same date of service and same provider.

Affected Code(s)

  • HCPCS/CPT Codes identified on the ASC Fee Schedule

Applicable Policy References

  • Title XVIII of the Social Security Act, Section 1833
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 14, Section 40