Do ambulatory surgery centers bill on ub-04?

Last Update: April 20, 2022

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Asked by: Lilian Pacocha
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Hospital-based ASCs use the UB-04 form, while freestanding ASCs generally use the CMS 1500 form. Payment for ASC services is HMSA's eligible charge less any member copayment and/or deductible.

What Bill type is used for ambulatory surgery center?

Consistent with the PROMISe™ Provider Handbook, all Ambulatory Surgery Centers (ASC) billing on a UB for services, should use a bill type 8XX and not the 13X used for outpatient facilities.

How does an ASC bill?

How are basic ASC charges coded and billed? An ASC uses a combination of physician and hospital or clinical billing, employing the CPT and HCPCS level codes (as do most physicians), some insurance carriers permit an ASC to bill using ICD-10 procedure codes as does a hospital.

How do ambulatory surgery centers get reimbursed?

CMS bases its reimbursement for outpatient procedures on its Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System. ... ASC payments are updated on an annual basis based on the Consumer Price Index for all urban consumers. For CY 2016, CMS proposes a 1.7 percent CPI-U update.

What is the CPT code for ambulatory surgery?

C1734 should always be billed with CPT codes 27870, 28715, 28725 (which are assigned to APC 5115 for CY 2020) and 28705 (which is assigned to APC 5116 for CY 2020).

Medical Billing Training — Do ASCs use CMS 1500 or UB 04 Forms

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