§416.120. Basis for payment.
42 C.F.R. § 416.120
The basis for payment depends on where the services are furnished.
Hospital outpatient department. Payment is in accordance with part 419 of this chapter.
[Reserved]
ASC—
General rule. Payment is based on a prospectively determined rate. This rate covers the cost of services such as supplies, nursing services, equipment, etc., as specified in § 416.61. The rate does not cover physician services or other medical services covered under part 410 of this chapter (for example, X-ray services or laboratory services) which are not directly related to the performance of the surgical procedures. Those services may be billed separately and paid on a reasonable charge basis.
Single and multiple surgical procedures.
If one covered surgical procedure is furnished to a beneficiary in an operative session, payment is based on the prospectively determined rate for that procedure.
If more than one surgical procedure is furnished in a single operative session, payment is based on—
The full rate for the procedure with the highest prospectively determined rate; and
One half of the prospectively determined rate for each of the other procedures.
Deductibles and coinsurance. Part B deductible and coinsurance amounts apply as specified in § 410.152 (a) and (i) of this chapter.
Notes, amendments, and revision history
Amendments
[56 FR 8844, Mar. 1, 1991; 56 FR 23022, May 20, 1991, as amended at 71 FR 68226, Nov. 24, 2006]
Authority
Authority: 42 U.S.C. 273, 1302, 1320b-8, and 1395hh.
Source
Source: 47 FR 34094, Aug. 5, 1982, unless otherwise noted.
Amendments
[56 FR 8844, Mar. 1, 1991; 56 FR 23022, May 20, 1991, as amended at 71 FR 68226, Nov. 24, 2006]