Ambulatory Surgery Center Fee Schedule 2009

Date: November 27, 2008

On November 18, 2008, the Federal Register published changes to the ASC payment system and 2009 payment rates. The Medicare Modernization Act (MMA) froze ASC payment rates through 2009, so changes were minimal. The freeze will be lifted in 2010, at which time the ASC conversion factor will update by the Consumer Price Index for Urban Consumers.

2009 marks the second transition year to the revised ASC payment system, which was implemented in 2008. The 2009 facility reimbursement rates are a 50/50 blend of calendar year 2007 ASC rates and revised ASC payment rates.

The following table shows a sample of facility fees comparing 2008 to 2009. These are national numbers and do not consider geographic adjustments.

CPT- 66984

Procedure – ECCE w IOL

2008 – $976.76

2009 –  $964.70

CPT- 66821

Procedure – YAG Capsulotomy

2008 – $288.20

2009 –  $258.60

CPT- 66180

Procedure – Aqueous Shunt*

2008 – $948.76

2009 –  $1,176.06

CPT- 65855

Procedure – Laser Trabeculoplasty

2008 – $132.53

2009 –  $136.33

CPT- 67028

Procedure – Intravitreal Injection

2008 – $82.45

2009 – $84.76

*Shunt device bundled in facility reimbursement

Ophthalmic additions to the ASC list include:

  • 65756 – DSEK
  • 0190T – Intraocular radiation SRC
  • 0191T – Insert anterior segment drainage device, internal
  • 0192T – Insert anterior segment drainage device, external

The definition of an ASC was revised to state, “a distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following admission.” This revision allows an ASC to keep a patient, if necessary, up to 23 hours and 59 minutes.

The Federal Register document can be found at: http://edocket.access.gpo.gov/2008/pdf/ E8-26212.pdf. Medicare contractors should begin to publish local ASC reimbursement rates on their websites shortly.

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