[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR416.120]



[Page 817]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 416_AMBULATORY SURGICAL SERVICES--Table of Contents

 

                 Subpart E_Payment for Facility Services

 

Sec. 416.120  Basis for payment.





    The basis for payment depends on where the services are furnished.

    (a) Hospital outpatient department. Payment is in accordance with 

part 413 of this chapter.

    (b) [Reserved]

    (c) ASC--(1) General rule. Payment is based on a prospectively 

determined rate. This rate covers the cost of services such as supplies, 

nursing services, equipment, etc., as specified in Sec. 416.61. The 

rate does not cover physician services or other medical services covered 

under part 410 of this chapter (for example, X-ray services or 

laboratory services) which are not directly related to the performance 

of the surgical procedures. Those services may be billed separately and 

paid on a reasonable charge basis.

    (2) Single and multiple surgical procedures. (i) If one covered 

surgical procedure is furnished to a beneficiary in an operative 

session, payment is based on the prospectively determined rate for that 

procedure.

    (ii) If more than one surgical procedure is furnished in a single 

operative session, payment is based on--

    (A) The full rate for the procedure with the highest prospectively 

determined rate; and

    (B) One half of the prospectively determined rate for each of the 

other procedures.

    (3) Deductibles and coinsurance. Part B deductible and coinsurance 

amounts apply as specified in Sec. 410.152 (a) and (i) of this chapter.



[56 FR 8844, Mar. 1, 1991; 56 FR 23022, May 20, 1991]