Section 416.120 - Basis for paymentThe basis for payment depends on where the services are furnished.
(a)Hospital outpatient department. Payment is in accordance with part 419 of this chapter.(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 . 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.(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) and (i) of this chapter.56 FR 8844, Mar. 1, 1991; 56 FR 23022, May 20, 1991, as amended at 71 FR 68226, Nov. 24, 2006