Ambulatory Surgical Center Payment Indicators
The Centers for Medicare & Medicaid Services (CMS) assigns an Ambulatory Surgical Center (ASC) Payment Indicator to each procedure code listed on the quarterly Approved HCPCS Code and Payment Rate file addenda. You can access the quarterly files on the CMS ASC Payment Rates – Addenda webpage under Related Links. The ASC Payment Indicator for a procedure code can be found on the Addendum AA, Addendum BB or Addendum FF tabs of each quarterly file addenda. The list of payment indicators and definitions can be found on Addendum DD1.
Here is the list of the ASC Payment Indicators for Calendar Year (CY) 2022.
|
Indicator |
Definition |
|---|---|
|
A2 |
Surgical procedure on ASC list in CY 2007; payment based on 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 MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight. |
|
P3 |
Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. |
|
R2 |
Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility 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 nonfacility PE RVUs. |