Wiki Infusions in ASC's

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Lisa Bledsoe

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Reaching out for some help here. Administration wants me to find documentation that infusions cannot be done in an ASC for Medicare and also non-Medicare. (ie remicade infusuions) I am certain this is true, but I don't know where to find it without spending an entire day searching. If anyone has any information or links I will be forever indebted!! :D
 
Asc infusion

It appears that neither chemotherapy nor infusion services have ever been allowed in an ambulatory surgery center setting for Medicare. The Claims Processing Manual, chapter 14, section 10.1 describes “An ASC for Medicare purposes is a distinct entity that operates exclusively for the purpose of furnishing outpatient surgical services to patients.”


Infusion and chemotherapy do not qualify as “surgical services” according to this description. The codes for these services are not included on the list of covered surgical procedures.

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 adjustments for regional wage variations, the wage adjusted payment rates, and wage indices are available on the CMS Web site at: http://www.cms.hhs.gov/ASCpayment/.

pasted from Code correct
hope this helps
 
Thank you. I spent a good portion of my day yesterday researching this to find the documentation that the powers-that-be requested (which I did find). Funny, they made an "attempt" but after 10 minutes they got lost on the CMS website and couldn't find a way out...lol.
 
We ran into this same situation with Remicade infusions. We now turn a couple rooms in the office into an infusion center a couple days a week. instead of the ASC. We can't bill a facility fee but it is still reimbursed well above the expenses and is very convenient and well received by the patients. Just a heads up, the billing and follow up on benefits is a nightmare though. Slow to pay so we have a lot of revenue tied up in meds until the payers finish running us through the ringer asking for notes etc. despite getting preauth.
 
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