Ambulatory Surgical Center Payment Indicators

Published 09/06/2023

The Centers for Medicare & Medicaid Services (CMS) Ambulatory Surgical Center (ASC) Payment Indicators (PIs) listed below define the ASC PIs included in the Medicare ASC fee schedule.

Indicator

Definition

A2 Surgical procedure on ASC list in CY 2007; payment based on Outpatient Perspective Payment System (OPPS) relative payment weight.
B5 Alternative code may be available; no payment made.
D5 Deleted/discontinued code; no payment made.
F4 Corneal tissue acquisition, hepatitis B vaccine; paid at reasonable cost.
G2 Non-office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
H2 Brachytherapy source paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate.
J7 OPPS pass-through device paid separately when provided integral to a surgical procedure on ASC list; payment contractor priced.
J8 Device-intensive procedure; paid at adjusted rate.
K2 Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate.
K5 Items, codes, and services for which pricing information and claims data are not available. No payment made.
K7 Unclassified drugs and biologicals; payment contractor priced.
L1 Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made.
L6 New Technology Intraocular Lens (NTIOL); special payment.
N1 Packaged service/item; no separate payment made.
P2 Office-based surgical procedure added to ASC list in CY 2008 or later with Medicare Physician Fee Schedule (MPFS) non-facility Practice Expense (PE) Relative Value Units (RVUs); payment based on OPPS relative payment weight.
P3 Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS non-facility PE RVUs; payment based on MPFS non-facility PE RVUs.
R2 Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS non-facility PE RVUs; payment based on OPPS relative payment weight.
Z2 Radiology or diagnostic service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight.
Z3 Radiology or diagnostic service paid separately when provided integral to a surgical procedure on ASC list; payment based on MPFS non-facility PE RVUs.

 


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