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ASC Payment Rates

ASC services are those surgical procedures that are identified by CMS on an annually updated ASC listing. The Medicare definition of covered facility services includes services that would be covered if furnished on an inpatient or outpatient basis in connection with a covered surgical procedure.

The complete lists of ASC covered surgical procedures and ASC covered ancillary services, the applicable payment indicators, payment rates for each covered surgical procedure and ancillary service before adjustment for regional wage variations, the wage adjusted payment rates, and wage indices are available at http://www.cms.gov/ascpayment/ This link takes you to an external website on the CMS website. Instructions are also available in the CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 14, Sections 30 and 40 This link takes you to an external website.

View the ASC procedures and payment amounts grouped by the Core-Based Statistical Area (CBSA) code. See the 'Urban Area/State Code' and be sure to select the appropriate CBSA to view fees for your facility.  

 

2017

Effective January 1, 2017

For dates of service on/after 1/1/17 – CMS Change Request (CR)9923

  • HI/Pacific Islands
    • Rural – 12 [Excel]
    • Guam – 65 [Excel]
    • Kalawao, Maui including Kahului-Wailuku-Lahaina – 27980 [Excel]
    • Urban Honolulu – 46520 [Excel]
  • Nevada
    • Rural – 29 [Excel]
    • Carson City – 16180 [Excel]
    • Las Vegas – 29820 [Excel]
    • Reno-Sparks – 39900 [Excel]
  • Northern California
    • California – 05 [Excel]
    • Bakersfield, Kern County – 12540 [Excel]
    • Chico, Butte County – 17020 [Excel]
    • Fresno, Fresno County – 23420 [Excel]
    • Hanford-Corcoran, Kings County – 25260 [Excel]
    • Madera, Madera County – 31460 [Excel]
    • Merced, Merced County – 32900 [Excel]
    • Modesto, Stanislaus County – 33700 [Excel]
    • Napa, Napa County – 34900 [Excel]
    • Oakland-Hayward-Berkeley, Alameda County, Contra Costa County – 36084 [Excel]
    • Redding, Shasta County – 39820 [Excel]
    • Riverside-San Bernardino-Ontario, Riverside County, San Bernardino County – 40140 [Excel]
    • Sacramento-Arden-Arcade-Roseville, El Dorado County, Placer County, Sacramento County, Yolo County – 40900 [Excel]
    • Salinas, Monterey County – 41500 [Excel]
    • San Francisco-Redwood City-South San Francisco, San Francisco County, San Mateo County – 41884 [Excel]
    • San Jose-Sunnyvale-Santa Clara, San Benito County, Santa Clara County – 41940 [Excel]
    • San Rafael, Marin County – 42034 [Excel]
    • Santa Cruz-Watsonville, Santa Cruz County – 42100 [Excel]
    • Santa Rosa, Sonoma County – 42220 [Excel]
    • Stockton-Lodi, San Joaquin County – 44700 [Excel]
    • Vallejo-Fairfield, Solano County – 46700 [Excel]
    • Visalia-Porterville, Tulare County – 47300 [Excel]
    • Yuba City, Sutter County, Yuba County – 49700 [Excel]
  • Southern California
    • Santa Ana-Anaheim-Irvine, Orange County – 11244 [Excel]
    • El Centro, Imperial County – 20940 [Excel]
    • Los Angeles-Long Beach-Glendale, Los Angeles County – 31084 [Excel]
    • Oxnard-Thousand Oaks-Ventura, Ventura County – 37100 [Excel]
    • San Diego-Carlsbad, San Diego County – 41740 [Excel]
    • San Luis Obispo-Paso Robles-Arroyo Grande, San Luis Obispo County – 42020 [Excel]
    • Santa Barbara-Santa Maria, Santa Barbara County – 42200 [Excel]

2016

Effective October 1, 2016

For dates of service on/after 10/1/16 - CMS Change Request (CR) 9773

Effective July 1, 2016

For dates of service on/after 7/1/16 - CMS Change Request (CR) 9668

Effective January 1, 2016

For dates of service on/after 1/1/16 – CMS Change Request (CR)9484

  • HI/Pacific Islands
    • Rural – 12 [Excel]
    • Guam – 65 [Excel]
    • Kalawao, Maui including Kahului-Wailuku-Lahaina – 27980 [Excel]
    • Urban Honolulu – 46520 [Excel]
  • Nevada
    • Rural – 29 [Excel]
    • Carson City – 16180 [Excel]
    • Las Vegas – 29820 [Excel]
    • Reno-Sparks – 39900 [Excel]
  • Northern California
    • California – 05 [Excel]
    • Bakersfield, Kern County – 12540 [Excel]
    • Chico, Butte County – 17020 [Excel]
    • Fresno, Fresno County – 23420 [Excel]
    • Hanford-Corcoran, Kings County – 25260 [Excel]
    • Madera, Madera County – 31460 [Excel]
    • Merced, Merced County – 32900 [Excel]
    • Modesto, Stanislaus County – 33700 [Excel]
    • Napa, Napa County – 34900 [Excel]
    • Oakland-Hayward-Berkeley, Alameda County, Contra Costa County – 36084 [Excel]
    • Redding, Shasta County – 39820 [Excel]
    • Riverside-San Bernardino-Ontario, Riverside County, San Bernardino County – 40140 [Excel]
    • Sacramento-Arden-Arcade-Roseville, El Dorado County, Placer County, Sacramento County, Yolo County – 40900 [Excel]
    • Salinas, Monterey County – 41500 [Excel]
    • San Francisco-Redwood City-South San Francisco, San Francisco County, San Mateo County – 41884 [Excel]
    • San Jose-Sunnyvale-Santa Clara, San Benito County, Santa Clara County – 41940 [Excel]
    • San Rafael, Marin County – 42034 [Excel]
    • Santa Cruz-Watsonville, Santa Cruz County – 42100 [Excel]
    • Santa Rosa, Sonoma County – 42220 [Excel]
    • Stockton-Lodi, San Joaquin County – 44700 [Excel]
    • Vallejo-Fairfield, Solano County – 46700 [Excel]
    • Visalia-Porterville, Tulare County – 47300 [Excel]
    • Yuba City, Sutter County, Yuba County – 49700 [Excel]
  • Southern California
    • Santa Ana-Anaheim-Irvine, Orange County – 11244 [Excel]
    • El Centro, Imperial County – 20940 [Excel]
    • Los Angeles-Long Beach-Glendale, Los Angeles County – 31084 [Excel]
    • Oxnard-Thousand Oaks-Ventura, Ventura County – 37100 [Excel]
    • San Diego-Carlsbad, San Diego County – 41740 [Excel]
    • San Luis Obispo-Paso Robles-Arroyo Grande, San Luis Obispo County – 42020 [Excel]
    • Santa Barbara-Santa Maria, Santa Barbara County – 42200 [Excel]

2015

Effective October 1, 2015

For dates of service on/after 10/1/15 and processed on/after 10/1/15 - CMS Change Request 9310

Effective July 1, 2015

  • HI/Pacific Islands
    • Rural – 12 [Excel]
    • Guam – 65 [Excel]
    • Kalawao, Maui including Kahului-Wailuku-Lahaina – 27980 [Excel]
    • Urban Honolulu – 46520 [Excel]
  • Nevada
    • Rural – 29 [Excel]
    • Carson City – 16180 [Excel]
    • Las Vegas – 29820 [Excel]
    • Reno-Sparks – 39900 [Excel]
  • Northern California
    • California – 05 [Excel]
    • Bakersfield, Kern County – 12540 [Excel]
    • Chico, Butte County – 17020 [Excel]
    • Fresno, Fresno County – 23420 [Excel]
    • Hanford-Corcoran, Kings County – 25260 [Excel]
    • Madera, Madera County – 31460 [Excel]
    • Merced, Merced County – 32900 [Excel]
    • Modesto, Stanislaus County – 33700 [Excel]
    • Napa, Napa County – 34900 [Excel]
    • Oakland-Hayward-Berkeley, Alameda County, Contra Costa County – 36084 [Excel]
    • Redding, Shasta County – 39820 [Excel]
    • Riverside-San Bernardino-Ontario, Riverside County, San Bernardino County – 40140 [Excel]
    • Sacramento-Arden-Arcade-Roseville, El Dorado County, Placer County, Sacramento County, Yolo County – 40900 [Excel]
    • Salinas, Monterey County – 41500 [Excel]
    • San Francisco-Redwood City-South San Francisco, San Francisco County, San Mateo County – 41884 [Excel]
    • San Jose-Sunnyvale-Santa Clara, San Benito County, Santa Clara County – 41940 [Excel]
    • San Rafael, Marin County – 42034 [Excel]
    • Santa Cruz-Watsonville, Santa Cruz County – 42100 [Excel]
    • Santa Rosa, Sonoma County – 42220 [Excel]
    • Stockton-Lodi, San Joaquin County – 44700 [Excel]
    • Vallejo-Fairfield, Solano County – 46700 [Excel]
    • Visalia-Porterville, Tulare County – 47300 [Excel]
    • Yuba City, Sutter County, Yuba County – 49700 [Excel]
  • Southern California
    • Santa Ana-Anaheim-Irvine, Orange County – 11244 [Excel]
    • El Centro, Imperial County – 20940 [Excel]
    • Los Angeles-Long Beach-Glendale, Los Angeles County – 31084 [Excel]
    • Oxnard-Thousand Oaks-Ventura, Ventura County – 37100 [Excel]
    • San Diego-Carlsbad, San Diego County – 41740 [Excel]
    • San Luis Obispo-Paso Robles-Arroyo Grande, San Luis Obispo County – 42020 [Excel]
    • Santa Barbara-Santa Maria, Santa Barbara County – 42200 [Excel]

Effective January 1, 2015 to June 30, 2015

  • HI/Pacific Islands

    • Rural - 12 [Excel]
    • Guam - 65 [Excel]
    • Kalawao, Maui including Kahului-Wailuku-Lahaina - 27980 [Excel]
    • Urban Honolulu - 46520 [Excel]
  • Nevada
    • Rural - 29 [Excel]
    • Carson City - 16180 [Excel]
    • Las Vegas - 29820 [Excel]
    • Reno-Sparks - 39900 [Excel]
  • Northern California
    • California - 05 [Excel]
    • Bakersfield, Kern County - 12540 [Excel]
    • Chico, Butte County - 17020 [Excel]
    • Fresno, Fresno County - 23420 [Excel]
    • Hanford-Corcoran, Kings County - 25260 [Excel]
    • Madera, Madera County - 31460 [Excel]
    • Merced, Merced County - 32900 [Excel]
    • Modesto, Stanislaus County - 33700 [Excel]
    • Napa, Napa County - 34900 [Excel]
    • Oakland-Hayward-Berkeley, Alameda County, Contra Costa County - 36084 [Excel]
    • Redding, Shasta County - 39820 [Excel]
    • Riverside-San Bernardino-Ontario, Riverside County, San Bernardino County - 40140 [Excel]
    • Sacramento-Arden-Arcade-Roseville, El Dorado County, Placer County, Sacramento County, Yolo County - 40900 [Excel]
    • Salinas, Monterey County - 41500 [Excel]
    • San Francisco-Redwood City-South San Francisco, San Francisco County, San Mateo County - 41884 [Excel]
    • San Jose-Sunnyvale-Santa Clara, San Benito County, Santa Clara County - 41940 [Excel]
    • San Rafael, Marin County - 42034 [Excel]
    • Santa Cruz-Watsonville, Santa Cruz County - 42100 [Excel]
    • Santa Rosa, Sonoma County - 42220 [Excel]
    • Stockton-Lodi, San Joaquin County - 44700 [Excel]
    • Vallejo-Fairfield, Solano County - 46700 [Excel]
    • Visalia-Porterville, Tulare County - 47300 [Excel]
    • Yuba City, Sutter County, Yuba County - 49700 [Excel]
  • Southern California
    • Santa Ana-Anaheim-Irvine, Orange County - 11244 [Excel]
    • El Centro, Imperial County - 20940 [Excel]
    • Los Angeles-Long Beach-Glendale, Los Angeles County - 31084 [Excel]
    • Oxnard-Thousand Oaks-Ventura, Ventura County - 37100 [Excel]
    • San Diego-Carlsbad, San Diego County - 41740 [Excel]
    • San Luis Obispo-Paso Robles-Arroyo Grande, San Luis Obispo County - 42020 [Excel]
    • Santa Barbara-Santa Maria, Santa Barbara County - 42200 [Excel]

Last Updated Mar 10, 2017