Procedure not payable in an ASC
Procedures not on the ASC covered procedures list are denied for facility payment.
How we prevent it: We check the covered list and payment indicator before scheduling.
AMBULATORY SURGERY BILLING
Ambulatory Surgery Billing Services
Ambulatory surgery centers bill facility fees on approved procedure lists, with multiple-procedure discounting and implant billing rules.
No upfront feesHIPAA-compliantSpecialty-trained coders
$0
Upfront or setup fees
0
Revenue cycle steps managed end to end
0
Specialties and lab types we bill for
0
Of your data and systems stay yours
OVERVIEW
Ambulatory Surgery billing done right
Ambulatory surgery centers bill facility fees on approved procedure lists. Medicare only pays ASCs for procedures on its ASC covered procedures list, and each procedure has a payment indicator that decides how it is paid, discounted or packaged.
Implants, device-intensive procedures, discontinued cases and multiple procedures all change the facility payment. Commercial payers have their own ASC fee schedules, carve-outs for implants and authorization rules.
We bill ASC facility claims from the operative report and implant log, apply payment indicators and discounting correctly, and make sure device and implant charges are captured under each contract.
Also see our medical coding, denial management, eligibility verification and revenue cycle management services.
CODING
Common ambulatory surgery CPT & HCPCS codes we bill
ASC facility claims use the same CPT codes as surgeons, but payment rules are different.
| Code | Description | What we watch for |
|---|---|---|
| 66984 | Extracapsular cataract removal with intraocular lens, routine | One of the highest-volume ASC procedures. |
| 45380 | Colonoscopy with biopsy, single or multiple | Screening modifiers affect patient cost sharing. |
| 43239 | EGD with biopsy, single or multiple | Endoscopy family rules apply to multiple procedures. |
| 64483 | Transforaminal epidural injection, lumbar or sacral, single level, with imaging | Imaging guidance is packaged. |
| 29881 | Knee arthroscopy with meniscectomy, medial or lateral | Payers may require authorization. |
| 64721 | Neuroplasty, median nerve at carpal tunnel | Laterality modifiers are required. |
| 27447 | Total knee arthroplasty | On the Medicare ASC list; device-intensive, with device codes required. |
| 52356 | Cystourethroscopy with ureteroscopy and lithotripsy, including stent | The stent is included. |
| 19120 | Excision of breast lesion, open, one or more lesions | Laterality modifiers are required. |
| C1776 | Joint device (implantable) | Device HCPCS codes are reported with device-intensive procedures. |
Code descriptions are summarized. CPT® is a registered trademark of the American Medical Association. Coverage and payment rules vary by payer and change every year; we code to the current code set and your payers’ policies.
Modifiers that matter in ambulatory surgery billing
73
Discontinued before anesthesiaFor cases cancelled after preparation but before anesthesia.
74
Discontinued after anesthesiaFor cases stopped after anesthesia was given.
RT / LT
Right and left sideRequired for paired organs and extremities.
PT
Screening turned diagnostic (Medicare)For screening colonoscopies that become diagnostic.
FB
Device provided at no costFor devices received free or with full credit.
DENIALS
Why ambulatory surgery claims get denied
The denial reasons we see most often in ambulatory surgery billing, with the claim adjustment reason code (CARC) payers usually attach, and what we do so they don't happen again.
Multiple procedure discount applied incorrectly
Procedures billed in the wrong order or without discount rules are underpaid.
How we prevent it: We sequence procedures by payment and apply discount rules.
Device code missing
Device-intensive procedures need the device HCPCS code on the claim.
How we prevent it: Implant logs are reconciled with the claim before submission.
No authorization
Commercial and Medicare Advantage plans often require authorization for ASC procedures.
How we prevent it: We confirm authorization and the approved site of service.
Item packaged into the facility payment
Supplies, anesthesia drugs and imaging are packaged and not separately payable.
How we prevent it: We only bill separately payable items under each contract.
HOW WE WORK
How we run your ambulatory surgery revenue cycle
From the first eligibility check to the final patient payment, one dedicated team handles every step and reports back to you.
01
Eligibility and authorization
We verify coverage, benefits, copays and deductibles before the visit. For ASCs, that includes authorizations, site-of-service approval and patient cost estimates.
02
Charge capture and coding
Our coders review documentation and assign CPT, HCPCS and ICD-10-CM codes to the highest supported specificity. Facility claims are coded from operative reports and implant logs.
03
Claim scrubbing and submission
Every claim is checked against NCCI edits, payer policies and modifier rules before it goes out electronically, so it is paid on the first pass.
04
Payment posting and reconciliation
We post ERAs and EOBs, compare payments to your contracted rates and flag underpayments for appeal.
05
Denial management and A/R follow-up
Every denial is worked: corrected, appealed or escalated, with root causes fed back to the front end. Payment indicator, device and contract denials are appealed with records and contract terms.
06
Reporting and patient billing
You get clear monthly reports on collections, denials and A/R aging, and patients get easy-to-read statements and answers to billing questions.
COMPLIANCE
Ambulatory Surgery payer rules we track for you
Rules that change how ambulatory surgery claims must be coded, documented and submitted.
ASC covered procedures list: Medicare only pays ASCs for listed procedures.
Payment indicators: decide whether a procedure is paid, packaged or subject to discounting.
Multiple procedures: most additional procedures are paid at 50% of the ASC rate.
Device-intensive procedures: require device HCPCS codes and adjust payment when devices are free.
FAQ
Ambulatory Surgery billing questions
Do you bill ASC facility fees only?
We bill ASC facility claims and can also bill professional fees for surgeons and anesthesia providers who work in your center.
How do you handle implant carve-outs?
We reconcile implant logs and invoices with each claim and bill implants separately where contracts allow.
Do you check if procedures are on the ASC list?
Yes. We check the covered list and payment indicators before scheduling Medicare cases.
How much do your ambulatory surgery billing services cost?
We charge a percentage of what we actually collect for you, with no upfront or setup fees. Your rate depends on claim volume and the services you need, so we quote it after a free review of your current billing.
Do we have to change our EHR or practice management system?
No. We work inside the systems you already use, and your data stays yours. We set up secure access, learn your workflows and start working claims without disrupting your front desk.
Related specialties
FREE AMBULATORY SURGERY BILLING REVIEW
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