Surgery Procedural Services

Citation

42 CFR § 416.120

Basis for payment.

The basis for payment depends on where the services are furnished.

Citation

42 CFR § 416.164

Scope of ASC services.

This section defines the scope of included facility services, covered ancillary services, and excluded services for ASC payment purposes.

Citation

42 CFR § 416.166

Covered surgical procedures.

This provision defines the criteria and safety standards for surgical procedures covered under the Medicare Ambulatory Surgical Center (ASC) payment system.

Citation

42 CFR § 416.167

Basis of payment.

This provision establishes the unit of payment and the methodology for classifying ASC services into Ambulatory Payment Classification (APC) groups for Medicare reimbursement.

Citation

42 CFR § 416.172

Adjustments to national payment rates.

This provision establishes the methodology for adjusting Medicare payment rates for ambulatory surgical center services, including geographic adjustments, multiple procedure discounting, and interrupted procedure policies.

Citation

42 CFR § 416.195

Determination of membership in new classes of new technology IOLs.

CMS establishes criteria for determining whether an intraocular lens (IOL) qualifies for a payment adjustment as a new technology IOL when inserted at an ambulatory surgical center.

Citation

42 CFR § 416.42

Condition for coverage—Surgical services.

Surgical procedures must be performed by qualified physicians with clinical privileges, and anesthesia services must be administered by qualified personnel with appropriate risk evaluation.

Citation

42 CFR § 416.44

Condition for coverage—Environment.

The ASC must maintain a safe, sanitary, and properly equipped environment that meets life safety and building code requirements to protect patient health.

Citation

42 CFR § 416.47

Condition for coverage—Medical records.

The ASC must maintain complete, accurate, and legible medical records for each patient, including specific documentation requirements for surgical procedures.

Citation

42 CFR § 416.52

Conditions for coverage—Patient admission, assessment and discharge.

Ambulatory Surgical Centers must ensure patients receive appropriate pre-surgical and post-surgical assessments and that all discharge requirements are met.

Citation

42 CFR § 416.61

Scope of facility services.

This provision outlines the specific items and services included in and excluded from facility services for Medicare payment purposes.

Citation

42 CFR § 416.65

Covered surgical procedures.

Effective for services furnished before January 1, 2008, covered surgical procedures are those procedures that meet the standards described in paragraphs (a) and (b) of this section and are included in the list published in accordance wi...

Citation

42 CFR § 416.75

Performance of listed surgical procedures on an inpatient hospital basis.

The inclusion of a procedure as a covered surgical procedure for ASCs does not preclude its coverage in an inpatient hospital setting.