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Title 42: Public Health
CHAPTER IV: CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)
SUBCHAPTER B: MEDICARE PROGRAM
PART 416: AMBULATORY SURGICAL SERVICES
Subpart E: Prospective Payment System for Facility Services Furnished Before January 1, 2008
416.125 - ASC facility services payment rate.
(a) The payment rate is based on a prospectively determined standard overhead amount per procedure derived from an estimate of the costs incurred by ambulatory surgical centers generally in providing services furnished in connection with the performance of that procedure.
(b) The payment must be substantially less than would have been paid under the program if the procedure had been performed on an inpatient basis in a hospital.
(c) For services furnished on or after January 1, 2007, and before the effective date of implementation of a revised payment system, the ASC payment rate for a surgical procedure is the lesser of the ASC payment rate established under paragraph (a) of this section or the prospective payment rate for the procedure established under ? 419.32 of this chapter. The lesser payment amount is determined prior to application of any geographic adjustment.
[56 FR 8844, Mar. 1, 1991, as amended at 71 FR 68226, Nov. 24, 2006]
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