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ASC billing with clean implant, multiple procedure and modifier rules
Facility billing for ambulatory surgery centers: Medicare’s covered procedures list, multiple procedure reductions, implants and more.
How ASC billing works
Medicare pays ASCs only for procedures on its ASC covered procedures list, and ASCs bill Medicare on the professional claim format (837P) with place of service 24. When several procedures are performed, the highest-paying procedure is paid in full and others are usually reduced by 50 percent.
Codes we bill every day
| Code | What it covers |
|---|---|
| POS 24 | Ambulatory surgical center |
| Modifier 73 | Procedure discontinued before anesthesia |
| Modifier 74 | Procedure discontinued after anesthesia started |
| Modifier 50 | Bilateral procedure |
| Implant HCPCS | Device and implant codes payable separately by some contracts |
Code descriptions are summarized. Payer coverage and documentation rules vary by plan and state.
Denials we prevent
- Procedures not on the payer’s ASC list
- Missing authorization for scheduled surgery
- Implants not billed or billed without invoices
- Multiple procedure order incorrect
- Commercial carve-outs not applied
Questions about ASC billing
Do you bill both facility and surgeon claims?
Yes, we can bill the ASC facility claim and the surgeons’ professional claims.
Get a free ASC billing audit
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.