Effective April 15, 2013, the Maximum Allowable Payment (MAP) for procedures performed in an Ambulatory Surgery Center will be calculated at 140% of the Medicare Payment for procedures plus the total cost of all surgical implants per case with Revenue Codes 274, 276, and 278 minus a five hundred ($500) implant cost reduction per case.  Ambulatory Surgery Centers are to utilize the “UB04” for all facility billing.

Revision Notice: Commission Amends Fee Schedule for Ambulatory Surgery Centers Surgically Implanted Devices (PDF) Ambulatory Surgery Center Fee Schedule for Surgically Implanted Devices Effective April 15, 2013. 

Claims for ambulatory surgery center services are paid at the Medicare national payment rate found at www.cms.gov/ASCPayment plus 40%.

Note: The multiple procedures rule still applies, and the National Correct Coding Initiative will be utilized in order to determine the appropriate billing of CPT and HCPCS codes.