Ask Caryl: ASC Fee Structure

Q: I want to make sure we are coding fully. What is included in the ASC's fee?

Caryl Serbin: The facility’s fee normally includes everything that is performed in the facility and by facility staff, including, but not limited to:

  • services provided by nursing, technical and business office personnel employed by the ASC;

  • facility overhead expenses (direct and indirect);

  • drugs, surgical supplies, splints, casts and appliances/equipment directly related to the surgical procedure, including most intraocular lenses (some special service IOLs may be billed for separately)

  • anesthesia supplies and materials;

  • administrative, billing and housekeeping services; and

  • diagnostic and therapeutic tests directly related to surgical procedure.

Fees that are not included in the facility fee and which may be billed separately by provider include, but are not limited to:

  • provider’s fee (physician, surgeon);

  • administration of anesthesia (anesthesiologist, CRNA);

  • ambulance services, if applicable;

  • durable medical equipment (DME) sale, lease, or rental for patient home use;

  • prosthetic implants, allografts, external fixators, etc.;

  • leg, arm and neck braces; and

  • lab, x-ray or diagnostic procedure not directly related to surgical procedure.

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