CSHCN 2009 > Hospital > Ambulatory Surgical Centers

22.5 Ambulatory Surgical Centers

22.5.1 Benefits, Limitations, and Authorization Requirements

Covered services in a freestanding surgical center or a hospital ambulatory surgical center are billed as one inclusive charge. It is not appropriate to bill separately for any supplies or other services related to the surgery. Routine X-ray and laboratory services directly related to the surgical procedure are not reimbursed separately. All nonroutine laboratory and X-ray services should be billed separately using the hospital's full care provider identifier.

Take-home drugs and supplies are not a benefit of the CSHCN Services Program.

All surgical procedures performed in an ASC or HASC must be billed using the appropriate national procedure code. Day surgery payment represents a global payment. Physician services must be billed separately.

Day surgery services include prosthetic devices, such as an intraocular lens (IOL), when supplied by the day surgery facility and implanted, inserted, or otherwise applied during a surgical procedure that is a benefit. Certain devices, such as cochlear implants and neurostimulator devices, may be reimbursed separately from the global rate.

Authorization for ASCs and HASCs

Authorization is required for all services performed in an ASC or HASC. Some outpatient surgery procedures have specialty team requirements. Refer to individual sections of this manual for additional information.

Refer to: Chapter 4, "Authorizations and Prior Authorizations," for more information, including deadlines and appeal procedures.

Appendix B, "CSHCN Services Program Prior Authorization and Authorization Request for Outpatient Surgery-For Outpatient Facilities and Surgeons".