A number of variables determine your specific Medicare payment rates for procedures on the ASC-payable list. The average rate update highlighted in the proposed and final payment rules (i.e., 2.1% for CY 2019) is an average across all covered procedures; individual procedures may increase or decrease by differing amounts. Specific rates are also adjusted for geographic differences via a local wage index and are subject to an across-the-board 2% reduction (called a sequester) until 2024, as mandated by the Budget Control Act of 2011.
As such, ASCA has worked to provide the Medicare Rate Calculator, a members-only resource that clearly and easily shows your Medicare payment rates for ASC-payable procedures. By selecting your state and county, the calculator automatically finds your local wage index and calculates the total payment, Medicare payment and beneficiary copayment for each procedure. The calculator is made available when new rates are released by CMS, most notably in the summer for the proposed payment rule and in the fall for the final payment rule. New calculators are also posted if CMS provides ad hoc updates to the payment rates at other times. Members should log in to view and download rate calculators.