Blue Cross Blue Shield TX ASC reimbursement update

ASC reimbursement and coverage note

When performed at an Ambulatory Surgery Center (ASC), the outpatient surgery CPT codes listed below are designated for an increased reimbursement rate. Presence on the list does not guarantee coverage under an individual member contract.

ASC reimbursement increase applies when the listed outpatient surgery CPT codes are performed at an Ambulatory Surgery Center.

Codes eligible for increased ASC reimbursement (partial)

Partial list — sample CPT codes eligible for an ASC reimbursement increase (effective dates shown where provided).

Examples

CPT 22102 — Partial excision of posterior vertebral component; Effective Date = 04/01/22.
CPT 22103 — Partial excision of posterior vertebral component; Effective Date = 03/15/23.
CPT 22510 — Percutaneous vertebroplasty; Effective Date = 04/01/22.
CPT 22511 — Percutaneous vertebroplasty; Effective Date = 04/01/22.
CPT 22551 — Arthrodesis, anterior interbody; Effective Date = 04/01/22.
CPT 22612 — Arthrodesis, posterior or posterolateral technique, single level; Effective Date = 04/01/22.

Reimbursement rule (excerpt)

Excerpt showing that listed codes are identified for an ASC reimbursement increase when performed at an Ambulatory Surgery Center.

CPT codes enumerated in this excerpt (e.g., 25115, 25116, 25118, 25120, 25125, 25126, 25130, 25135) receive an increased reimbursement when performed at an ASC; Effective Date = 04/01/22 for entries shown.

Reimbursement code list (no additional criteria)

Informational list — CPT codes listed with their Effective Date indicating ASC reimbursement increase.

Sample entries

CPT 26542 — Reconstruction, collateral ligament, metacarpophalangeal joint; Effective Date = 04/01/22.
CPT 26545 — Reconstruction, collateral ligament, interphalangeal joint; Effective Date = 04/01/22.
CPT 26546 — Repair non-union, metacarpal or phalanx; Effective Date = 04/01/22.
CPT 27705 — Osteotomy; tibia; Effective Date = 04/01/22.
CPT 27707 — Osteotomy; fibula; Effective Date = 04/01/22.

Code applicability

Codes and descriptions with effective dates indicating applicability for the ASC reimbursement increase.

Code applicability examples

CPT 27720 — Repair of nonunion or malunion, tibia; without graft; Effective Date = 04/01/22.
CPT 27726 — Repair of fibula nonunion and/or malunion with internal fixation; Effective Date = 04/01/22.
CPT 27827 — Open treatment of distal tibia (pilon) fracture; Effective Date = 04/01/22.

ASC reimbursement — CPT eligibility (partial)

Partial fragment — orthopedic arthroscopy and related codes eligible for ASC reimbursement increase (effective dates as shown).

Arthroscopy examples

CPT 29824 — Arthroscopy, shoulder, distal claviculectomy; Effective Date = 04/01/22.
CPT 29825 — Arthroscopy, shoulder; lysis and resection of adhesions; Effective Date = 04/01/22.
CPT 29826 — Arthroscopy, shoulder; decompression of subacromial space; Effective Date = 04/01/22.
CPT 29827 — Arthroscopy, shoulder; with rotator cuff repair; Effective Date = 04/01/22.
CPT 29830 — Arthroscopy, elbow, diagnostic; Effective Date = 03/15/23.

ASC reimbursement — code list (partial)

Partial code listing — cardiac device and selected procedural codes eligible for ASC reimbursement increase (effective dates shown).

ANY of the following

CPT 33223 — Revision or relocation of skin pocket for implantable cardioverter-defibrillator; Effective Date = 04/01/22.
CPT 33224 — Insertion of pacing electrode, cardiac venous system, for left ventricular pacing; Effective Date = 04/01/22.
CPT 33286 — Removal, subcutaneous cardiac rhythm monitor; Effective Date = 04/01/22.
CPT 36002 — Injection procedure for percutaneous treatment of extremity pseudoaneurysm; Effective Date = 04/01/22.

ASC reimbursement-eligible codes (code list)

Examples from GI and endoscopy groups included in the ASC reimbursement increase list (effective dates shown).

ANY of the following

CPT 43236 — Upper GI endoscopy with directed submucosal injections; Effective Date = 04/01/22.
CPT 43260 — ERCP; diagnostic; Effective Date = 04/01/22.
CPT 45378 — Colonoscopy, flexible, proximal to splenic flexure; diagnostic; Effective Date = 04/01/22.

ASC reimbursement increase code list (partial)

Partial listing — biliary, laparoscopic and hernia procedure codes included with effective dates for ASC reimbursement increase.

ANY of the following

CPT 47537 — Removal of biliary drainage catheter, percutaneous; Effective Date = 04/01/22.
CPT 47562 — Laparoscopy, surgical; cholecystectomy; Effective Date = 04/01/22.
CPT 49561 — Repair initial incisional hernia, incarcerated or strangulated; Effective Date = 04/01/22.

Billing applicability

Urology/endoscopic procedure examples eligible for ASC reimbursement increase (effective dates shown).

ANY of the following

CPT 52400 — Cystourethroscopy with incision, fulguration or resection of congenital urethral valves; Effective Date = 04/01/22.
CPT 52402 — Cystourethroscopy with transurethral resection or incision of ejaculatory ducts; Effective Date = 04/01/22.
CPT 52450 — Transurethral incision of prostate; Effective Date = 04/01/22.

ASC reimbursement code listing (no detailed criteria in this segment)

Informational — assorted neurosurgical, ENT and pain/procedure codes included for ASC reimbursement increase (effective dates shown).

ANY of the following

CPT 60212 — Partial thyroid lobectomy with contralateral subtotal lobectomy; Effective Date = 04/01/22.
CPT 61020 — Ventricular puncture through previous burr hole; Effective Date = 04/01/22.
CPT 62326 — Injection(s) including indwelling catheter placement; Effective Date = 03/15/23 (exception).

ASC reimbursement increase code list (partial)

Additional partial list — ENT, cardiac, vascular and miscellaneous codes included with effective dates for ASC reimbursement increase.

ANY of the following

CPT 69633 — Tympanoplasty without mastoidectomy with ossicular chain reconstruction; Effective Date = 04/01/22.
CPT 92920 — Percutaneous transluminal coronary angioplasty; Effective Date = 04/01/22.
CPT 92928 — Percutaneous transcatheter placement of intracoronary stent(s); Effective Date = 04/01/22.
CPT 93451 — Right heart catheterization including measurements; Effective Date = 04/01/22.
HCPCS C9600 — Percutaneous transcatheter placement of drug eluting intracoronary stent(s); Effective Date = 04/01/22.

CPT / HCPCS Codes and Examples

sample ASC-incentivized outpatient surgery CPT codesCPTCovered

10005	FINE NEEDLE ASPIRATION BIOPSY, INCLUDING ULTRASOUND GUIDANCE; FIRST LESION
11450	EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH SIMPLE OR INTERMEDIATE REPAIR
15273	APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA >=100 SQ CM; FIRST 100 SQ CM
19081	BIOPSY, BREAST, WITH PLACEMENT OF BREAST LOCALIZATION DEVICE(S); PERCUTANEOUS; FIRST LESION, STEREOTACTIC GUIDANCE
19300	MASTECTOMY FOR GYNECOMASTIA
22612	ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; LUMBAR

Sample spine/vertebral procedure codesCPTCovered

22102	PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT... LUMBAR
22103	PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT...
22510	PERCUTANEOUS VERTEBROPLASTY... CERVICOTHORACIC
22511	PERCUTANEOUS VERTEBROPLASTY... LUMBOSACRAL

Sample elbow/humerus procedure codesCPTCovered

24363	ARTHROPLASTY, ELBOW; WITH DISTAL HUMERUS AND PROXIMAL ULNAR PROSTHETIC REPLACEMENT (TOTAL ELBOW).
24545	OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE...

Sample CPT codes from excerptCPTCovered

25115	RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS; FLEXORS
25116	RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS
25118	SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT
25120	EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA

Hand/upper extremity codes (partial list)CPTCovered

26542	RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH LOCAL TISSUE (EG, ADDUCTOR ADVANCEMENT)
26545	RECONSTRUCTION, COLLATERAL LIGAMENT, INTERPHALANGEAL JOINT, SINGLE, INCLUDING GRAFT, EACH JOINT
26546	REPAIR NON-UNION, METACARPAL OR PHALANX, (INCLUDES OBTAINING BONE GRAFT WITH OR WITHOUT EXTERNAL OR INTERNAL FIXATION)

Hip/knee/major lower extremity codes (partial list)CPTCovered

27130	ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP REPLACEMENT) WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
27447	ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA RESURFACING (TOTAL KNEE REPLACEMENT)
27570	MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA ((INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION DEVICES)

ASC-increased reimbursement CPT list (partial window)CPTCovered

27705	OSTEOTOMY; TIBIA
27707	OSTEOTOMY; FIBULA
27709	OSTEOTOMY; TIBIA AND FIBULA
27720	REPAIR OF NONUNION OR MALUNION, TIBIA; WITHOUT GRAFT
27726	REPAIR OF FIBULA NONUNION AND/OR MALUNION WITH INTERNAL FIXATION
27732	EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL FIBULA
27752	CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE
27758	OPEN TREATMENT OF TIBIAL SHAFT FRACTURE WITH PLATE/SCREWS
27759	OPEN TREATMENT OF TIBIAL SHAFT FRACTURE BY INTRAMEDULLARY IMPLANT
27762	CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE

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Orthopedic arthroscopy (partial)CPTCovered

29824	Arthroscopy, shoulder (glenoid articular cartilage, biceps tendon, labrum, etc.)
29825	Arthroscopy, shoulder; distal claviculectomy
29826	Arthroscopy, shoulder; lysis and resection of adhesions
29827	Arthroscopy, shoulder; decompression of subacromial space
29828	Arthroscopy, shoulder; rotator cuff repair
29830	Arthroscopy, elbow, diagnostic
29834	Arthroscopy, elbow; removal of loose body
29835	Arthroscopy, elbow; synovectomy, partial
29836	Arthroscopy, elbow; synovectomy, complete

Hip and knee arthroscopy (partial)CPTCovered

29860	Arthroscopy, hip, diagnostic
29863	Arthroscopy, hip; synovectomy
29870	Arthroscopy, knee, diagnostic
29880	Arthroscopy, knee; with meniscectomy
29882	Arthroscopy, knee; with meniscus repair

ENT / nasal procedures (partial)CPTCovered

30115	Excision, nasal polyp(s) extensive
30400	Rhinoplasty, primary; lateral and alar cartilages
30468	Repair of nasal valve collapse (effective 03/15/23)
30520	Septoplasty or submucous resection (effective 03/15/23)

Nasal/sinus and laryngoscopy codes (partial)CPTCovered

31255	Nasal/sinus endoscopy with ethmoidectomy, total
31300	Laryngotomy with removal of tumor or cordectomy
31525	Direct laryngoscopy; diagnostic

Bronchoscopy / pulmonary procedures (partial)CPTCovered

31624	Bronchoscopy with bronchial alveolar lavage
31628	Bronchoscopy with transbronchial lung biopsy
31652	Bronchoscopy with EBUS guided sampling (1-2 nodes)
31653	Bronchoscopy with EBUS guided sampling (3+ nodes)

Cardiac device procedures (partial)CPTCovered

33206	Insertion/replacement of permanent pacemaker with atrial lead
33207	Insertion/replacement of permanent pacemaker with ventricular lead
33208	Insertion/replacement of permanent pacemaker with atrial and ventricular leads
33233	Removal of permanent pacemaker pulse generator
33240	Insertion/replacement of implantable cardioverter-defibrillator pulse generator only

Selected CPT codes (partial list)CPTCovered

33223	REVISION OR RELOCATION OF SKIN POCKET FOR IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR
33224	INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING...
33226	REPOSITIONING OF PREVIOUSLY IMPLANTED CARDIAC VENOUS SYSTEM (LEFT VENTRICULAR) ELECTRODE
33227	REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR WITH REPLACEMENT; SINGLE LEAD
33228	REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR WITH REPLACEMENT; DUAL LEAD
36512	THERAPEUTIC APHERESIS; FOR RED BLOOD CELLS
37197	TRANSCATHETER RETRIEVAL, PERCUTANEOUS, OF INTRAVASCULAR FOREIGN BODY
43235	UPPER GASTROINTESTINAL ENDOSCOPY; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMENS

Upper GI endoscopy group (examples)CPTCovered

43236	Upper GI endoscopy w/ directed submucosal injections
43237	Upper GI endoscopy w/ endoscopic ultrasound limited to esophagus
43238	Upper GI endoscopy w/ transendoscopic ultrasound-guided FNA/biopsy

ERCP and related procedures (examples)CPTCovered

43260	ERCP; diagnostic
43262	ERCP; with sphincterotomy/papillotomy
43450	Dilation of esophagus

Colonoscopy and lower GI endoscopy (examples)CPTCovered

45378	Colonoscopy proximal to splenic flexure; diagnostic
45380	Colonoscopy; with biopsy
45390	Colonoscopy; with endoscopic mucosal resection

Listed CPT codes with descriptions (partial list from this segment)CPTCovered

47537	REMOVAL OF BILIARY DRAINAGE CATHETER, PERCUTANEOUS, REQUIRING FLUOROSCOPIC GUIDANCE
47538	PLACEMENT OF STENT(S) INTO A BILE DUCT, PERCUTANEOUS
47539	PLACEMENT OF STENT(S) INTO A BILE DUCT, PERCUTANEOUS
47540	PLACEMENT OF STENT(S) INTO A BILE DUCT, PERCUTANEOUS
47554	BILIARY ENDOSCOPY, PERCUTANEOUS T-TUBE; WITH REMOVAL OF STONE(S)
47562	LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY
48102	BIOPSY OF PANCREAS, PERCUTANEOUS NEEDLE
49082	ABDOMINAL PARACENTESIS; WITHOUT IMAGING GUIDANCE
49250	UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS
49320	LAPAROSCOPY, SURGICAL, ABDOMEN, PERITONEUM, OMENTUM; DX

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Urology/Endoscopic procedures (sample from list)CPTCovered

52400	Cystourethroscopy with incision, fulguration or resection congenital urethral valves
52402	Cystourethroscopy with transurethral resection or incision of ejaculatory ducts
52450	Transurethral incision of prostate

Genitourinary / Male genital procedures (sample)CPTCovered

54401	Insertion of penile prosthesis; inflatable (self-contained)
54520	Orchiectomy, simple
54690	Laparoscopy, surgical; orchiectomy

Gynecologic procedures (sample)CPTCovered

57288	Sling operation for stress incontinence
58345	Transcervical introduction of fallopian tube catheter (note: effective 03/15/23)
58542	Laparoscopy, supracervical hysterectomy with removal of tube(s) and/or ovary(s)

Sample codes from the listCPT

60212	Partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy
60220	Total thyroid lobectomy, unilateral; with or without isthmusectomy
60225	Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy
60280	Excision of thyroglossal duct cyst or sinus
60512	Autotransplant parathyroid

Listed outpatient surgery/ASC codes (partial)mixedCovered

69633	Tympanoplasty without mastoidectomy; with ossicular chain reconstruction and synthetic prosthesis
69635	Tympanoplasty with antrotomy or mastoidotomy; without ossicular chain reconstruction
69641	Tympanoplasty with mastoidectomy; without ossicular chain reconstruction
69642	Tympanoplasty with mastoidectomy; with ossicular chain reconstruction
69643	Tympanoplasty with mastoidectomy; with intact or reconstructed canal wall, without ossicular chain reconstruction
92920	Percutaneous transluminal coronary angioplasty; single major coronary artery or branch
92928	Percutaneous transcatheter placement of intracoronary stent(s), single major coronary artery or branch
93451	Right heart catheterization including measurements
93452	Left heart catheterization including ventriculography
93985	Duplex scan of arterial inflow and venous outflow for preop

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Exception effective dates

Exception examplesSome CPT codes in the list show later effective dates; example: CPT 28092 effective 03/15/23.

Scope of exceptionsExceptions are limited to specific codes listed with 03/15/23 effective dates rather than the baseline date.

Implication for billingWhen a code shows a later effective date (03/15/23), the ASC reimbursement increase applies from that later date for that code.

Effective dates

Baseline effective date for most codesMost CPT codes listed show Effective Date = 04/01/22.

Selected later effective datesA subset of codes are shown with a later Effective Date = 03/15/23 (examples: 29830, 30468, 30520).

Per‑code effective dateEach CPT entry includes its own effective date — use the date shown for that specific code when applying ASC reimbursement increases.

Effective date baseline

Primary effective dateMost CPT procedure codes in this policy are effective 04/01/22.

Use for majority of listTreat 04/01/22 as the baseline effective date unless a specific code entry states a different date.

DocumentationThe effective date is listed per code in the CPT entries and should be referenced on claims/billing files.

Exceptions

Noted exceptionsSome listed CPT codes are annotated with Effective Date = 03/15/23 (examples include 58345 and 58559).

Apply per codeWhen an exception appears, the later date governs applicability of the ASC reimbursement increase for that code.

Check code entriesBilling staff should verify the effective date shown on each CPT entry before applying the increased ASC reimbursement.

Provider Billing and Documentation Guidance

Billing Rule

ASC reimbursement increase code list — provider billing note

The following CPT/HCPCS outpatient surgery codes receive an increased reimbursement rate when performed at an Ambulatory Surgery Center (ASC) under Blue Cross and Blue Shield of Texas commercial plans. Billing staff should indicate place-of-service and report the appropriate facility modifier where required. This excerpt does not include prior authorization requirements or documentation instructions — check the full policy for any authorization rules.

Coverage caveat: Increased reimbursement applies only when the listed procedure is performed at an ASC and billed with the correct place-of-service; medical necessity and other plan terms still apply.
This callout lists sample codes and effective dates; the full policy contains the complete code list.

Note

Reimbursement increase code list (partial)

Sample codes (partial list) with effective dates and brief descriptions to assist billing identification. This is a partial excerpt; consult the full policy for the complete code set.

22102 — 04/01/22: Partial excision of posterior vertebral component; lumbar.
22103 — 03/15/23: Partial excision of posterior vertebral component (partial text shown).
22510 — 04/01/22: Percutaneous vertebroplasty; 1 vertebral body, cervicothoracic.
22511 — 04/01/22: Percutaneous vertebroplasty; 1 vertebral body, lumbosacral.
22513 — 04/01/22: Percutaneous vertebral augmentation (kyphoplasty), 1 vertebral body.

Billing Rule

Additional code list (partial)

Additional sample codes (partial continuation) for billing identification. Effective dates shown are the policy effective date unless otherwise noted in the individual entry.

23450 — (no effective date shown in excerpt): Capsulorrhaphy, anterior; Putti-Platt or Magnuson type.
23455 — 04/01/22: Capsulorrhaphy, anterior; Bankart type operation.
23462 — 04/01/22: Capsulorrhaphy, anterior, with coracoid process transfer.
23465 — 04/01/22: Capsulorrhaphy for recurrent dislocation, posterior.
23466 — 04/01/22: Capsulorrhaphy for multidirectional instability.

Note

Reimbursement listing (no auth rules included)

More provider-facing CPT examples (partial). This excerpt demonstrates that the policy lists many procedure codes across specialties that are eligible for an ASC reimbursement increase; no prior authorization or documentation steps are included in these excerpts.

25115 — 04/01/22: Radical excision of bursa, synovia of wrist or forearm tendon sheaths; flexors.
25116 — 04/01/22: Radical excision of bursa, synovia of wrist or forearm tendon sheaths.
26542 — 04/01/22: Reconstruction, collateral ligament, metacarpophalangeal joint, single.
26545 — 04/01/22: Reconstruction, collateral ligament, interphalangeal joint, each.
26546 — 04/01/22: Repair non-union, metacarpal or phalanx (includes obtaining bone graft).

Billing Rule

ASC reimbursement increase — CPT code listing (partial)

Additional provider-facing CPT examples (partial) to aid coding staff in identifying ASC-eligible procedures and effective dates. This list is illustrative and not exhaustive.

29824 — 04/01/22: Arthroscopy, shoulder; distal claviculectomy.
29827 — 04/01/22: Arthroscopy, shoulder; with rotator cuff repair.
33223 — 04/01/22: Revision or relocation of skin pocket for implantable cardioverter-defibrillator.
43236 — 04/01/22: Upper GI endoscopy with directed submucosal injections.
47537 — 04/01/22: Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance.

Definitions and Terms

ASC reimbursement increase / coverage caveat

DefinitionASC reimbursement increase: a payer adjustment that provides increased reimbursement when listed outpatient surgery CPT codes are performed at an Ambulatory Surgery Center (ASC).

ApplicabilityApplies only when the listed CPT procedure is performed at an Ambulatory Surgery Center as indicated in the code list.

Coverage caveatPresence on the list does not necessarily indicate coverage under a member's benefits contract; member contract terms still apply.

Ambulatory Surgery Center (ASC) reimbursement increase

Policy adjustmentAmbulatory Surgery Center (ASC) reimbursement increase is a payer policy adjustment that increases reimbursement for specified outpatient CPT procedure codes when performed at an ASC.

Per‑code basisThe adjustment is applied to specific CPT codes enumerated in the policy; each code entry includes an effective date.

Claims implicationProviders should bill with the correct CPT and place-of-service to reflect ASC to receive the adjusted reimbursement where applicable.

Ambulatory Surgery Center (ASC) — setting definition

Setting definitionAmbulatory Surgery Center (ASC): a facility setting where the listed outpatient surgery CPT codes receive increased reimbursement when the procedure is performed there.

Performance requirementIncreased reimbursement applies only when the procedure is actually performed at an ASC (not in other outpatient settings).

List‑drivenOnly CPT codes included in the policy's ASC list are eligible for the ASC reimbursement increase.

04/01/22 — Effective Date

Effective date metadata04/01/22 is listed in the policy as the Effective Date applied to many CPT entries in the ASC reimbursement list.

Per‑entry detailEach CPT code entry shows its own Effective Date field; use the per‑code Effective Date for implementation.

Baseline vs exceptions04/01/22 functions as the baseline effective date for the majority of codes; exceptions are noted per code where applicable.

ASC reimbursement increase (restated)

Restated policyASC reimbursement increase: listed outpatient surgery CPT codes are designated for an increased reimbursement rate when performed at an Ambulatory Surgery Center.

List evidenceThe policy enumerates numerous CPT codes (with descriptions and effective dates) indicating which procedures receive the ASC reimbursement increase.

Provider actionBilling staff should reference the code list and effective dates when submitting claims to ensure appropriate reimbursement.

Reimbursement increase when performed at an Ambulatory Surgery Center

Short definitionReimbursement increase applies when the listed CPT code is performed at an Ambulatory Surgery Center.

Effective date noteEach code includes an Effective Date; some codes list 03/15/23 as an exception to the 04/01/22 baseline.

Operational noteClaims should reflect ASC place‑of‑service to qualify for the adjusted reimbursement.

Endobronchial ultrasound guided sampling (EBUS)

EBUS abbreviationEBUS = Endobronchial ultrasound guided sampling (used in bronchoscopy CPT entries such as 31652/31653).

ContextEBUS is referenced in bronchoscopy CPT descriptions indicating the technique used for guided sampling during the procedure.

Relevance for ASC listEBUS‑guided bronchoscopy CPTs are included in the ASC reimbursement list with effective dates noted.

ASC reimbursement increase (repeated)

Definition repeatASC reimbursement increase: CPT codes designated in the policy receive increased reimbursement when the procedure is performed at an Ambulatory Surgery Center.

List basisThe policy explicitly lists CPT entries (with descriptions and effective dates) that qualify for the ASC reimbursement increase.

No authorization instructionsThese list segments do not include prior authorization or additional coverage criteria; they serve as billing guidance for reimbursement adjustment.

ASC reimbursement increase (restated segment)

Repeated definitionASC reimbursement increase applies to the CPT procedure codes listed when performed at an Ambulatory Surgery Center.

Per‑code effective datesEach code entry includes an Effective Date; the effective date shown for each code governs when the increased reimbursement becomes applicable.

Provider verificationProviders should verify both code inclusion and effective date before applying ASC reimbursement on claims.

ASC reimbursement increase — short definition

Short definitional entryASC reimbursement increase: codes designated receive increased payment when performed at an Ambulatory Surgery Center.

Application noteThis adjustment is contingent on the procedure location (ASC) and the code being on the enumerated list.

Exception handlingIf a code entry shows a different effective date, use that date for the reimbursement change for that code.

ASC reimbursement increase — codes designated

Designation of codesCodes enumerated in the list are designated for an increased reimbursement rate when performed at an Ambulatory Surgery Center (ASC).

Implementation instructionBilling should reflect ASC place‑of‑service for the eligible CPT codes to receive the increased reimbursement.

Coverage caveatInclusion on the list does not guarantee coverage under every member contract; verify member benefits as needed.

Availity — term reference

Term referenceAvaility: trademark of Availity, LLC — a third‑party health information network referenced in the source document.

ContextAvaility is mentioned in the policy's footer/notes regarding administrative services and third‑party vendors.

BCBSTX noteBCBSTX makes no endorsement or warranties regarding third party vendors such as Availity.

OpenPayer

Outpatient Surgery Codes with Reimbursement Increase When Performed at an Ambulatory Surgery Center

Coverage Criteria for ASC Reimbursement Increase

CPT / HCPCS Codes and Examples

Provider Billing and Documentation Guidance

Definitions and Terms