01
Prior authorization and eligibility
Coverage verified at scheduling, not the day of surgery. Authorization status tracked through date of service for every case.
Ambulatory surgery center billing services
Ambulatory surgery center billing services
ASC billing runs on a separate payment system most billing teams were never trained on: facility fees under Ambulatory Payment Classifications, not the physician fee schedule. Implant reimbursement splits between pass-through and packaged categories. The multiple procedure reduction follows a 100/50/50 rule. And Medicare will not pay a facility fee for any procedure not on the ASC Covered Procedures List. We are an ASC billing company built for that reality, handling ASC medical billing and ASC revenue cycle management exclusively.
5-day onboarding | $0 setup | 50 states
Why ASC billing breaks differently than physician billing
Why ASC billing breaks differently than physician billing
A
Physician billing
PFS · One claim · Lower denial
Physician practices bill professional fees under the Medicare Physician Fee Schedule. One claim per encounter. One payment per service. Standard CPT coding with modifier rules physicians already know. Denial rates are lower than ASC rates and most are recoverable. See our physician billing services for that side.
B
ASC facility billing
APC · Two claims per case · 16-22% denial
ASCs bill facility fees under Ambulatory Payment Classifications, separate from the surgeon's professional fee. The facility claim covers nursing, supplies, equipment, and the operating room. Two claims per case, each with its own adjudication path.
16-22%
ASC first-pass denial rate. Hospital outpatient departments bill under OPPS at higher rates through our hospital billing services. According to Medical Billers and Coders' 2026 ASC industry report, ASCs experience significantly higher first-pass denial rates than physician groups, driven by implant billing complexity, prior authorization denials, and NCCI bundling violations.
Risingtrend
ASC claim denial rates have increased in recent years among multi-OR facilities, driven by infrastructure gaps that general billing platforms are not built to catch.
How the ASC payment system works
How the ASC payment system works
2.6%
CY 2026 rate increase
CMS increased ASC rates by 2.6% for CY 2026. Facilities that fail Quality Reporting requirements face a 2.0 percentage point payment reduction on top.
54.5%
Of the OPPS rate
Medicare ASC rates sit at approximately 54.5% of the OPPS rate for comparable procedures. Half the margin on every claim means half the tolerance for coding errors.
573
New CPL codes in CY 2026
CMS added 573 new codes to the ASC Covered Procedures List for CY 2026. An outdated charge master bills for procedures Medicare rejects or misses newly covered ones.
The coding accuracy that drives these payments runs through our medical coding team.
Medicare reimburses ASCs based on the Ambulatory Payment Classification system. Each covered procedure is assigned to an APC group with a fixed facility payment. CMS updates rates annually.
Multiple procedure reduction
When multiple procedures run in the same session, the highest-paying pays at 100% and each additional pays at 50%. Billing every procedure at full rate triggers a recoupment demand from the payer.
⚠ Consequence: recoupment demand from payer
Pass-through versus packaged implants
Pass-through implants bill separately using HCPCS C-codes. Packaged implants are bundled into the APC rate. Billing a packaged implant separately triggers CARC 96, and missing a pass-through means lost revenue.
⚠ Consequence: CARC 96 denial or missed revenue
ASC Covered Procedures List
Medicare will not pay an ASC facility fee for a procedure not on the CPL. CMS updates the list annually and added 573 codes for CY 2026. An outdated charge master misses newly covered procedures.
⚠ Consequence: zero payment on uncovered procedures
What our surgery center billing services cover
What our surgery center billing services cover
02
Charge capture from OR logs
Operative reports and supply logs reconciled against the billing record for every case. Missed implant and supply charges flagged.
03
APC coding and claim submission
NCCI edit updates tracked on each CMS quarterly release. Modifiers 50, 51, 59, SG, LT/RT, and XE/XS/XP/XU managed per procedure.
04
Implant billing and classification
Pass-through implants billed with HCPCS C-codes. Packaged items verified against APC rate. Every implant classified before submission.
05
Denial management and appeals
Root cause analysis, correction, and resubmission or appeal within 48 hours. Denial patterns tracked across your volume to prevent recurrence.
06
Coverage discovery and verification
Self-pay write-offs converted to billable claims through payer database sweeps. Out-of-network cases verified and patient responsibility set.
The cost of running ASC billing in-house
The cost of running ASC billing in-house
In-house
$46,660
Median salary BLS May 2024
Well above base
Loaded cost per staff member (salary, benefits, overhead, training)
- Minimum 2+ staff needed for coverage
- Denial queue grows during staff turnover
- ASC-specific APC and implant expertise rare
- AR damage surfaces weeks after the problem starts
Outsourced
Varies
Of net collections, by scope, volume, and specialty mix
Scales
With collection volume, no fixed staffing cost
- Coding + denial management + credentialing + reporting
- No turnover gap, denial queue never stops
- ASC-specific billing expertise included
- Scales with case volume, no staff hiring required
The decision depends on case volume, specialty mix, and whether the current in-house team can keep denial rates below 10% and AR under 40 days. When staff turns over, the denial queue grows and nobody notices until the AR aging report surfaces the damage.
Built for every ASC specialty
Built for every ASC specialty
Orthopedics
Joint replacements, arthroscopy, and spine procedures. We manage implant pass-through billing, device offset calculations, and bilateral and staged modifier logic on every case.
Pain management
Epidural steroid injections, nerve blocks, radiofrequency ablation, and spinal cord stimulator trials. Prior authorization verified by payer and procedure before every scheduled case.
Gastroenterology
EGD and colonoscopy at high volume with tight APC margins. We reconcile biopsy and polypectomy findings against the operative report to bill the correct procedure code.
Ophthalmology
Cataract surgery (CPT 66984), glaucoma, and retinal procedures. Modifiers LT/RT and 50 for laterality and bilateral applied per payer. IOL implant charges captured separately.
ENT and general surgery
Tonsillectomy, septoplasty, hernia repair, and cholecystectomy. NCCI edit compliance and multiple procedure reduction managed on every multi-procedure session at the center.
Multi-specialty ASCs
Billing workflows configured per specialty across the center. APC groups, modifier rules, and payer requirements managed separately rather than one generic rule set for all cases.
Works with your existing ASC systems
Works with your existing ASC systems
No system replacement. No workflow disruption. Billing connects to your existing credentialing and AR recovery workflows from a single team.
HST PathwaysSIS (Surgical Information Systems)AmkaiSolutionsAdvancedMD30+ others
ASC billing questions we get asked
ASC billing questions we get asked
Direct answers for surgery center administrators and billing teams evaluating ASC billing services.
What is ASC in billing?
ASC stands for Ambulatory Surgery Center. In billing, an ASC is a facility that performs outpatient surgical procedures and bills a facility fee separately from the surgeon's professional fee. The facility fee covers the operating room, nursing, equipment, and supplies. ASCs are reimbursed under the Ambulatory Payment Classification system for Medicare and under individual contracts for commercial payers.
What is the difference between ASC billing and hospital outpatient billing?
Both handle outpatient surgical procedures, but the payment systems differ. Hospital outpatient departments bill under the Outpatient Prospective Payment System (OPPS) at higher rates. ASCs bill under the ASC payment system, where rates are set at approximately 54.5% of OPPS. ASCs use the CMS-1500 form with Place of Service 24, while hospital outpatient uses the UB-04 with POS 22. Modifier rules, covered procedure lists, and implant billing also differ between the two settings.
How is ASC billing different from physician billing?
ASCs bill facility fees under the APC system, separate from the surgeon's professional fee. The facility claim covers the operating room, nursing, supplies, and equipment. Physician billing covers the surgeon's work. ASCs also deal with implant pass-through billing, the ASC Covered Procedures List, and the multiple procedure reduction rule, none of which apply to physician billing.
Can an ASC bill on a UB-04 form?
Most freestanding ASCs bill on the CMS-1500 (837P) form using Place of Service code 24. Some state Medicaid programs and certain commercial contracts require the UB-04 (837I) format. Hospital-based ASCs typically use the UB-04. We configure claim format rules per payer to prevent form-related rejections.
What is the ASC Covered Procedures List?
The ASC Covered Procedures List is the CMS list of surgical procedures eligible for Medicare facility fee payment in an ASC. If a procedure is not on the CPL, Medicare will not pay a facility fee for it. CMS updates the CPL annually. For CY 2026, 573 new procedure codes were added. Charge masters must be updated each year.
How do you handle implant and supply billing?
We reconcile operative reports and supply logs against the billing record for every case. Pass-through implants are billed separately using HCPCS C-codes. Packaged implants are included in the APC rate and cannot be billed as separate line items. We verify every implant classification to prevent missed revenue and CARC 96 denials.
What causes the most ASC claim denials?
Missing or expired prior authorizations, CPT coding errors, modifier misuse, NCCI bundling violations, documentation gaps, and eligibility issues. ASCs experience significantly higher first-pass denial rates than physician groups, driven by billing complexity that general platforms do not handle well.
How do I get started?
Request a free revenue assessment. We review your denial rate by root cause, implant charge capture accuracy, APC coding patterns, and payer contract performance. You receive a written report with findings and recommendations. No obligation, no upfront cost, and you keep the report whether or not you work with us.
Ready when you are
Your center runs the cases. We collect the revenue.
The free revenue assessment covers your denial rate by root cause, implant charge capture accuracy against OR logs, APC coding patterns, and estimated recoverable revenue. You keep the findings whether or not you work with us.
- Denial rate by root cause from your ASC claim volume
- Implant charge capture accuracy against OR logs
- APC coding pattern review
- Estimated recoverable revenue
- HIPAA-compliant, BAA signed before data moves
- No setup fee. No long-term contract.