CMS clarifies payment for implants, prosthetics
CMS clarifies payment for implants, prosthetics
The Centers for Medicare & Medicaid Services has clarified Medicare policy for payment and billing of services such as implants and prosthetics that are not covered by the ambulatory surgery center (ASC) facility fee. The notice informs providers about which additional services are to be paid and to whom they are to be billed.
According to the Federated Ambulatory Surgery Association, the advice includes:
- Durable medical equipment (DME). If the ASC furnishes DME to patients, it is treated as a DME supplier, and all the rules and conditions that are ordinarily applicable to DME are applicable to the ASC, including obtaining a supplier number and billing the DME regional carrier (DMERC) where applicable.
If the ASC furnishes items of implantable DME to patients, the ASC bills the local carrier for the surgical procedure and the implantable device and receives payment from the local carrier for those items. - Prosthetic devices. An ASC may bill and receive separate payment for prosthetic devices, other than the intraocular lenses (IOLs) that are implanted, inserted, or otherwise applied by surgical procedures on the ASC list of approved procedures. The ASC bills the local carrier and receives payment according to the DME equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule. (For additional examples of services that can be provided in ASCs, see list. To view the transmittal, go to http://fasa.org/CMSImplants506.pdf.)
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