ASC Payment Indicators

Indicator Description
A2 Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight
B5 Alternative coded may be available; no payment made
D5 Deleted/discontinued code; no payment made
F4 Corneal tissue acquisition; hepatitis B vaccine; paid at reasonable cost
G2 Non-office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
H2 Brachytherapy source paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate.
J7 OPPS pass-through device paid separately when provided integral to a surgical procedure on an ASC list; payment contractor-priced. Require invoice information.
J8 Device-intensive procedure; paid at adjusted rate
K2 Drugs and biologicals paid separately when provided integral to a surgical procedure on an ASC list' payment based on OPPS rate
K5 Items, codes, and services for which pricing information and claims data are not available. No payment made
K7 Unclassified drugs and biologicals; payment contractor-priced
L1 Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made.
L6 New Technology Intraocular Lens (NTIOL); special payment
N1 Packaged service/item; no separate payment made
P2 Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight.
P3 Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVU; payment based on MPFS nonfacility PE RVUs.
R2 Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight
Z2 Radiology or diagnostic service paid separate when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight.
Z3 'Radiology or diagnostic service paid separately when provided integral to a surgical procedure on ASC list; payment based on MPFS nonfacility PE RVUs.

 

Last Updated Dec 09 , 2023