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Q. Under the revised Ambulatory Surgical Center (ASC) payment system, CMS implemented a new policy for instances in which ASCs receive full credit for a replacement device, or receive the replacement device at no cost. How should these cases be billed?

Patient Financial Services Weekly Advisor, January 18, 2008

Q. Under the revised Ambulatory Surgical Center (ASC) payment system, CMS implemented a new policy for instances in which ASCs receive full credit for a replacement device, or receive the replacement device at no cost. How should these cases be billed?

A. The same policy related to full credit and no cost implantable device replacement that applies to the outpatient prospective payment system (OPPS) will apply to ASC payments.

That is, when a replacement device is supplied to the ASC at no cost or with full credit by the manufacturer, Medicare ASC payment for the procedure to implant the device will be reduced by the device portion of the ASC payment to account for the lower cost to the facility to furnish the procedure.

Medicare provides the same amount of payment reduction based on the estimated device cost included in the ASC procedure payment that would apply under the OPPS for performance of those procedures under the same circumstances. The beneficiary coinsurance will be adjusted to reflect the reduced payment amount.

ASCs should report the occurrence of a no cost or full credit device to CMS by reporting the -FB modifier on the line with the procedure code in which the no cost or full credit device is used when the device is on the list of specified devices to which this policy applies.

Remember that payment for devices is typically packaged into payment for the device implantation procedure, and ASCs should not report packaged devices as a separate line item on the claim.

The lists of affected devices, covered ASC surgical procedures, and reduction amounts are located at http://www.cms.hhs.gov/HospitalOutpatientPPS/ on the CMS website.

Source: The Centers for Medicare & Medicaid Services

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