Question
Our physicians employ an audiologist within our practice. We would like to be able to do an ABR at an Ambulatory Surgery Center on a child under one. Are we able to bill for this? Our ASC is stating that they will not be reimbursed as it is not an approved procedure at an ASC according to Medicare. Is our only option a hospital setting?
Answer
The Medicare program maintains a list of procedures approved for payment of an ASC facility fee when performed in an ASC. However, any procedure may be performed in the ASC when it is not open for the performance of surgical services. Such practices will not jeopardize the ASC's Medicare certification. For a one year-old child the level of payment is not controlled by Medicare rules. For Medicare beneficiaries receiving an ABR, payment would be the nonfacility rate (equivalency to a physician's office) under the physician fee schedule. (reference: Federal Register, November 1, 2001, p. 55264)
Mark L. Kander is director of Health Care Regulatory Analysis at the American Speech-Language-Hearing Association (ASHA). He has served in ASHA's Government Relations and Public Policy cluster for 15 years. Mr. Kander can be reached at mkander@asha.org.
Mark Kander
Director, Health Care Regulatory Analysis
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