Free-standing surgery centers, or Ambulatory Surgery Centers (ASCs), are used as an alternative to hospital outpatient departments. According to Medicare regulations, ASCs may be associated with a hospital, but may not be administratively or financially linked to the hospital, and patients who undergo procedures in the ASC may not be registered in the hospital.

• Medicare covers a number of procedures in the ASC. The procedures are assigned to one of nine groups, each of which is paid at a prospectively set rate.
• The ASC facility payment for all procedures in each group is established at a single rate, adjusted for geographic variation. The rate is a standard overhead amount that covers the cost of services such as nursing, supplies used, and costs of the facility and equipment.

The following information may help provide a context for ASCs engaged in the coding and payment process for the IDET* procedure:

• CPT modifiers
• Private insurers

Modifiers indicate that a service was altered in some way from the stated CPT descriptor without changing the definition. The American Medical Association (AMA) CPT modifiers are two-digit numeric codes listed after a procedure code and separated from the CPT code by a hyphen. The following CPT modifiers may be relevant to the IDET procedure:

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Private insurers cover ambulatory surgical services that are considered medically necessary and within the benefit structure of the patient’s health insurance coverage.

• Payment for the IDET procedure may be based on a percentage of the billed or allowed charges, per diem, or on a negotiated payment rate.
• Check with your payor organizations to determine the payment methodology for the IDET procedure.

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For further help with insurance and reimbursement, use our Reimbursement Calculation Tools.