Ambulatory surgery centers · Nationwide
Billing for ambulatory surgery centers
Facility claims follow different rules from professional claims: covered-procedure lists, multiple-procedure discounting, implant billing and payer-specific contracts. We bill the facility side so every case is paid in full.
Where surgery centers lose money
Facility vs. professional claims
The ASC claim and the surgeon's claim go out separately, on the form and with the codes each payer expects. We keep them in step.
Implants and carve-outs
Many contracts pay implants or specific cases separately. Without invoices and carve-out terms on the claim, that money is lost.
Covered procedures and discounting
Payers decide which procedures they will pay in an ASC and how multiple procedures are discounted. We check claims against those rules.
Contract underpayments
We compare payments with each payer contract and appeal underpaid cases.
What we handle
- ASC facility claims
- Implant and device billing
- Contract carve-outs and case rates
- Multiple-procedure discounting review
- Prior authorization checks
- Pain, orthopedic, spine and other surgical cases
Also included
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How it worksFAQ
Ambulatory surgery centers billing questions
How does ASC billing differ from the surgeon's billing?
The ASC bills a facility fee for the room, staff, supplies and equipment, separate from the surgeon's professional fee. Medicare ASC claims use the professional claim format (CMS-1500 / 837P), while some commercial payers want the institutional format (UB-04 / 837I).
Which procedures will payers cover in an ASC?
Medicare publishes a list of covered ASC procedures every year, and commercial payers set their own lists in their contracts. A procedure that is not on a payer's list may not be paid at all.
How are multiple procedures paid in an ASC?
Medicare and most payers pay the highest-paying procedure in full and reduce the others, often by 50%. Some procedures are exempt. Checking each discount against the contract is one of the most common ways to find underpayments.
How are implants paid in an ASC?
It depends on the payer. Medicare pays some devices separately or through higher rates for device-intensive procedures, and many commercial contracts carve out implants and pay invoice cost plus a percentage. Collecting it takes the invoice and the right codes on the claim.
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