Medicare Payments: ASC List Exclusion Criteria

Medicare pays for surgical procedures in an ASC unless the Centers for Medicare & Medicaid Services (CMS) determine that the procedures meet any of the following criteria for exclusion:

  • Is on the inpatient only list

  • Poses a significant safety risk to the beneficiary

  • Typically requires active medical monitoring and care past midnight

  • Directly involves major blood vessels

  • Requires major or prolonged invasion of body cavities

  • Generally results in extensive blood loss

  • Is emergent in nature

  • Is life-threatening in nature

  • Commonly requires systemic thrombolytic therapy

  • Can only be reported using an unlisted surgical procedures code