---
kind: "section"
citation: "42 C.F.R. § 416.120"
title: "42"
number: "416.120"
heading: "Basis for payment."
url: "https://uscodex.org/cfr/42/416.120"
---

# §416.120. Basis for payment.


The basis for payment depends on where the services are furnished.

- (a) **Hospital outpatient department.** Payment is in accordance with [part 419](/cfr/42/part419.md) of this chapter.
- (b) [Reserved]
- (c) **ASC—**
  - (1) **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](/cfr/42/416.61.md). The rate does not cover physician services or other medical services covered under [part 410](/cfr/42/part410.md) 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.
  - (2) **Single and multiple surgical procedures.**
    - (i) 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.
    - (ii) If more than one surgical procedure is furnished in a single operative session, payment is based on—
      - (A) The full rate for the procedure with the highest prospectively determined rate; and
      - (B) **One half of the prospectively determined rate for each of the other procedures.**
  - (3) **Deductibles and coinsurance.** Part B deductible and coinsurance amounts apply as specified in § [410.152 (a)](/cfr/42/410.152.md?p=a) and [(i)](/cfr/42/410.152.md?p=i) of this chapter.

## Notes

### 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]