Get your Practice Analysis done free of cost. Please call 888-720-8884

Ambulatory Surgery Medical Billing basics you ought to know

From the outset ASC billing (Ambulatory Surgery Center) is totally different than any other type of medical billing specialty. And as an Ambulatory Surgery Center biller and coder, it’s important to understand what the basics are.

Basically, ambulatory surgery center is a facility that specializes in outpatient treatments. Some of these procedures are meant to be surgeries, while others are pain management or diagnostic procedures like colonoscopies. Usually, the procedures done at an ASC are more extensive than those performed at the typical medical provider’s office. However, they are not so involved that they require a hospital stay.

In order for an ASC facility to bill for its services, it first needs to qualify certain requirements. Plus, they also need to enter into a written agreement with CMS.

Another vital point of ASCs to get paid is to determine the medical necessity, and the process to claim reimbursement. However, the medical procedure doesn’t have to be performed at an ASC facility and it is up to both the provider and the patient.

Is ASC a medical specialty or not?

Do remember that Ambulatory Service Center billing and coding isn’t centered on a specific medical specialty. And in such a scenario it doesn’t revolve around specific kinds of services, procedures, or diagnoses. What this means is that ASC billing is not like medical specialty billing, where you have to learn a few highly specialized guidelines or rules to make sure you are reimbursed for your services.

  • ASC billing is completely different than either regular medical billing or specialty billing!
  • Nevertheless this doesn’t mean that to be an ASC biller you have to learn a completely new set of codes or billing techniques. Keep in mind that ASC billing service does use all of the same codes, billing techniques, and many of the same billing and coding guidelines by the entire medical industry.
  • What makes ASC billing so different is that it’s like billing hospital codes through a CMS claim form, which is not a facility claim form
  • While hospitals use the UB-04 claim form, doctor’s facility and other outpatient healthcare providers use the CMS-1500 form. In this case, ASCs are no different, and use the typical provider form
  • An easy way to think of it is like this: Ambulatory Service Centers are like having every medical specialty all rolled into one
  • You can go there for a cast, a colonoscopy, or for surgical dressings. But, you can’t go there for a sick visit and get a diagnosis from a primary care physician
  • ASCs only provide services to those who already have a diagnosis from a primary care physician, and who need medically necessary procedures performed.

Types of services covered under ASC reimbursement

To be precise while conducting ASC claims filing remember that the services covered depends on the type of facility. Much of what is or isn’t covered under ASC guidelines depends on the ASC facility status.

There are also some services that can be provided by an ASC which are considered covered, even though they’re not considered ASC services:

  • Non-Implantable Durable Medical Equipment
  • Leg, Arm, Back and Neck Braces
  • Physician’s Services
  • Prosthetic Devices
  • Independent Laboratory Services
  • Ambulance Services
  • Artificial Legs, Arm, and Eyes
  • Implantable Durable Medical Equipment

Are you looking for ASC medical billing services? You can reach out to Medisys billing manager at

About Medisys

We are a group of medical billing experts who offer comprehensive billing and coding services to doctors, physicians & hospitals. We provide end to end billing and coding solutions. Medisys Data Solutions RCM solutions ensures that the providers recover every $ they are entitled to. Our vision for the providers is “You Cure. We $ecure.”

Share this post