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Ambulatory Surgical Center (ASC) Reimbursement
Description
An Ambulatory Surgical Centers (ASC) is a healthcare facility that provides same-day surgical care.
Durable Medical Equipment (DME) are devices intended for repeated or everyday use.
Policy
Blue Cross Blue Shield North Carolina (Blue Cross NC) will not provide reimbursement for DME in an ASC as outlined in this policy.
Reimbursement Guidelines
Durable Medical Equipment “E” codes are not eligible for separate reimbursement in an ASC, as indicated by place of service (24).
Rationale
Blue Cross NC reimburses ASCs at all-inclusive rates. DME provided for member use while in an ASC, is therefore considered included in the all-inclusive rate.
Billing and Coding
Applicable codes are for reference only and may not be all inclusive. For further information on reimbursement guidelines, please see the Blue Cross NC web site at Blue Cross NC.
HCPCS Code: EO-E802
Description: Durable Medical Equipment
Related policy
Bundling Guidelines
References
Blue Cross NC Provider Manual https://www.bluecrossnc.com/providers/emanuals/provider-blue-book
CMS Chapter 20 – DMEPOS Medicare Claims Processing Manual (cms.gov)
History
12/31/2021 Content extracted from provider manual and developed into policy to clarify and summarize DME reimbursement in an ASC. (eel)
12/31/2022 Routine policy review. Minor revisions in formatting only. (ckb)
Application
These reimbursement requirements apply to all commercial, Administrative Services Only (ASO), and Blue Card Inter-Plan Program Host members (other Plans members who seek care from the NC service area). This policy does not apply to Blue Cross NC members who seek care in other states.
This policy relates only to the services or supplies described herein. Please refer to the Member's Benefit Booklet for availability of benefits. Member's benefits may vary according to benefit design; therefore member benefit language should be reviewed before applying the terms of this policy.
Disclosures:
Reimbursement policy is not an authorization, certification, explanation of benefits or a contract. Benefits and eligibility are determined before medical guidelines and payment guidelines are applied. Benefits are determined by the group contract and subscriber certificate that is in effect at the time services are rendered. This document is solely provided for informational purposes only and is based on research of current medical literature and review of common medical practices in the treatment and diagnosis of disease. Medical practices and knowledge are constantly changing and Blue Cross NC reserves the right to review and revise its medical and reimbursement policies periodically.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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