Certified Suppliers That Enroll Via the Form CMS-855B / Ambulatory Surgical Centers (ASCs)
A. General Background Information
An ASC is defined in 42 CFR §416.2 as any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following an admission; the entity must have an agreement with CMS to participate in Medicare as an ASC, and must meet the conditions set forth in 42 CFR Part 416, subparts B and C. (The ASC supplier agreement (Form CMS-370) is similar to the provider agreement signed by Part A providers.)
As stated in §416.26(a), CMS may deem an ASC to be in compliance with any or all of the ASC conditions of coverage if:
• The ASC is accredited by a national accrediting body, or licensed by a state agency, that CMS determines provides reasonable assurance that the conditions are met;
• In the case of deemed status through accreditation by a national accrediting body, where state law requires licensure, the ASC complies with state licensure requirements; and • The ASC authorizes the release to CMS of the findings of the accreditation survey.
Unless CMS deems the ASC to be in compliance with the ASC conditions of coverage, a state survey will be performed.
ASCs can be fixed locations or mobile in nature.
B. ASCs and Hospitals
See the following instructions for guidance regarding hospital-operated/affiliated ASCs:
• Pub. 100-04, Claims Processing Manual, chapter 14, section 10.1
• Pub. 100-02, Benefit Policy Manual, chapter 15, section 260.1
C. Additional Information
For more information on ASCs, refer to:
• 42 CFR Part 416
• Pub. 100-07, State Operations Manual, chapter 2, section 2210 and Appendix L
• Pub. 100-02, Benefit Policy Manual, chapter 15, sections 260 – 260.5.3
• Pub. 100-04, Claims Processing Manual, chapter 14
• Also, see Pub. 100-07, State Operations Manual, chapter 2, section 2210, for information regarding the sharing of space between ASCs and other providers.
A. General Background Information
An ASC is defined in 42 CFR §416.2 as any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following an admission; the entity must have an agreement with CMS to participate in Medicare as an ASC, and must meet the conditions set forth in 42 CFR Part 416, subparts B and C. (The ASC supplier agreement (Form CMS-370) is similar to the provider agreement signed by Part A providers.)
As stated in §416.26(a), CMS may deem an ASC to be in compliance with any or all of the ASC conditions of coverage if:
• The ASC is accredited by a national accrediting body, or licensed by a state agency, that CMS determines provides reasonable assurance that the conditions are met;
• In the case of deemed status through accreditation by a national accrediting body, where state law requires licensure, the ASC complies with state licensure requirements; and • The ASC authorizes the release to CMS of the findings of the accreditation survey.
Unless CMS deems the ASC to be in compliance with the ASC conditions of coverage, a state survey will be performed.
ASCs can be fixed locations or mobile in nature.
B. ASCs and Hospitals
See the following instructions for guidance regarding hospital-operated/affiliated ASCs:
• Pub. 100-04, Claims Processing Manual, chapter 14, section 10.1
• Pub. 100-02, Benefit Policy Manual, chapter 15, section 260.1
C. Additional Information
For more information on ASCs, refer to:
• 42 CFR Part 416
• Pub. 100-07, State Operations Manual, chapter 2, section 2210 and Appendix L
• Pub. 100-02, Benefit Policy Manual, chapter 15, sections 260 – 260.5.3
• Pub. 100-04, Claims Processing Manual, chapter 14
• Also, see Pub. 100-07, State Operations Manual, chapter 2, section 2210, for information regarding the sharing of space between ASCs and other providers.
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