CurrentCareFirstPolicy N/A

Standard Approved Ambulatory Surgery Center (ASC) Codes

List of CPT/HCPCS procedure codes approved by CareFirst for reimbursement when performed in an ambulatory surgery center (ASC); codes not listed are not eligible for payment.

Policy Summary

PayerCareFirst

PolicyStandard Approved Ambulatory Surgery Center (ASC) Codes

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJune 2, 2025

Next Review DateN/A

Key ActionUse only the procedure codes listed in this document for ASC reimbursement; codes not listed are not eligible for payment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

manyASC-approved codes listed (partial)

2025-06-02Effective date

partialList completeness

part 3 of 4Document part

ASC Reimbursement Eligibility

ASC code eligibility

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ASC code inclusion (excerpt)

The following excerpt enumerates procedure code mappings and equivalencies that CareFirst approves for Ambulatory Surgery Center (ASC) payment.

ALL of the following

Examples of mapped/equivalent CPT groups in this excerpt
- 26541, 26591 = 26852 (example mapping shown in excerpt).
- 26541 paired with multiple codes (e.g., 27043 = 27246; 27324 = 27395; 27427 = 27532; 27606 = 27681) as listed in excerpt.
- 43257 mapped/equated to multiple CPT codes (e.g., 43259–43281, 43450, 43752*, 43887*, 44340, etc.) as shown in excerpt.
Codes and mappings shown are illustrative and part of a larger ASC code list.
This is a partial excerpt of the ASC-approved code mappings; the full document contains additional mappings and equivalencies.

ASC-approved code listing (partial)

Partial listing of CPT/HCPCS procedure codes and code equivalencies designated by CareFirst as approved for ASC reimbursement (excerpt). This section contains code groupings/equivalencies rather than clinical coverage criteria.

ALL of the following

CPT code 43257 is listed as equivalent/associated with many CPT codes (examples in excerpt include 43259, 43260, 43261, 43262, 43263, 43264, 43265, 43266, 43270, 43274, 43275, 43276, 43277, 43278, 43280, 43281, 43450, 43752*, 43755*, 43887*, 44340, 44360, 44361, 44363, 44364, 44365, 44370, 44372, 44377, 44378, 44379).
Ophthalmology/endoscopy examples: 65140 mapped to numerous related CPT codes (e.g., 65150, 65155, 65175, 65235, 65260 … 66170) as shown in excerpt.
Retina/eye procedure examples: 67030 mapped to many related CPT codes (e.g., 67031, 67036, 67039, 67040, 67041, 67042, 67107, 67108, 67218, 67227, 67250, etc.) and 67413 mapped to multiple related codes.
Ear/nose/throat and related groups: 68525 mapped to numerous related CPT codes (e.g., 68540, 68550, 68700, 68720, 68810, 69110, 69424* etc.) and 69511 mapped to many related CPT codes.
Mixed CPT/HCPCS/J-code examples: 69700 is listed with multiple CPT equivalents (e.g., 69710, 69711, 69714, 69716, 69717, 69719, 69720, 69726, 69727, 69728, 69729, 69730, 69740, 69745, 69801, 69805, 69806, 69905, 69910, 69915, 69930) and with HCPCS/Codes C2638, C2639, C2640, C2641, J0666, V2785 as shown in excerpt.

ASC Code Listings

Excerpted ASC-approved procedure code listings and equivalencies (additional codes continue throughout the full document).

ALL of the following

Group examples shown in this excerpt include: 65140 mapped to many ophthalmology-related CPT codes (see excerpt).
66172 and related ophthalmic codes are listed as part of ASC-approved groups in the excerpt.
67030 and 67413 are shown with multiple related retina/ocular CPT code mappings in the excerpt.
68525 and 69511 are displayed with numerous related ENT/otologic CPT codes in the excerpt (some codes are marked with an asterisk indicating exemption from multiple procedure reduction).
69700 is listed with many CPT equivalents and also with HCPCS/J/V codes (C2638, C2639, C2640, C2641, J0666, V2785) in the excerpt.
Codes not listed in the full document are not eligible for ASC payment per CareFirst policy.
This excerpt is not exhaustive; the full ASC code list extends beyond these chunks and the document indicates some codes are exempt from multiple procedure reduction (asterisked).

Approved ASC Procedure Codes (Excerpt)

Sample of ASC-approved codes (document contains many more)CPTCovered

0213T
0216T
0234T
11971
12005
15200

ASC approved procedure code mappings (partial list)CPTCovered

26541	CPT code listed in ASC mappings
26591	CPT code listed in ASC mappings
26852	CPT code listed as mapping result
27680	CPT code listed
27720	CPT code listed
27894	CPT code used repeatedly as mapping source in excerpt
28825	CPT code mapping group
30468	CPT code mapping group
32550	CPT code (asterisked in excerpt)
33206	CPT code listed

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Examples from ASC-approved CPT codes (partial)CPTCovered

43257	Listed as equivalent/associated with multiple CPT codes (e.g., 43259–43281, etc.)
43752	Included in list (marked with *)

Example CPT group (partial)CPTCovered

50970

Associated with multiple CPT codes (e.g., 50972, 50974, … 52317)

Excerpt of ASC-approved CPT/HCPCS codesmixedCovered

65140	Listed as equivalent/associated with many ophthalmology/endoscopic CPT codes in ASC list
66172	Included in ASC list
67030	Listed with multiple related CPT codes
67413	Listed with multiple related CPT codes
67914	Listed with multiple related CPT codes
68525	Listed with multiple related CPT codes
69511	Listed with multiple related CPT codes
69700	Listed with multiple related CPT codes and HCPCS/Codes J/C/V
C2638	HCPCS code included in ASC list
J0666	J-code included in ASC list

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Completeness of ASC code excerpt

Completeness (excerpt)This excerpt contains a partial, non-exhaustive set of ASC codes (part 2 of 4); the full ASC list continues in other document parts.

Document rangeCodes shown in this excerpt are drawn from document chunks 18–37 (partial listing).

Implication for reimbursementCodes not included in this excerpt should not be assumed eligible without consulting the complete ASC code list.

Effective date for codes in fileEffective as of June 2, 2025 (applies to codes across the full list).

Document scope — ASC code enumeration (partial)

Scope — ASC-approved codes enumeratedThis document part enumerates CPT/HCPCS procedure codes and mappings designated for Ambulatory Surgery Center reimbursement; it is an excerpt and not a complete policy section.

No clinical criteria included in excerptThe listed chunks provide code mappings and lists only; no clinical coverage criteria, prior authorization, or documentation rules are specified in this part.

Use for billingUse the codes listed here to determine ASC reimbursement eligibility; confirm against the complete ASC code list for codes not shown in this excerpt.

Excerpt positionThis file is part of a multi-part ASC code list (this excerpt represents part 2 of 4).

Billing and Authorization Notes

Billing Rule

ASC reimbursement eligibility

The following list of Standard Approved ASC Codes are approved by CareFirst and eligible for reimbursement in an ASC setting. Codes not listed are not eligible for payment.

Codes with an asterisk (*) are exempt from multiple procedure reduction.
These codes are effective as of June 2, 2025.

Billing Rule

ASC code list (no authorization rules in excerpt)

This section provides mappings and lists of CPT/HCPCS procedure codes that CareFirst designates as approved for ASC reimbursement; the excerpt does not specify any prior authorization, documentation, denial risk, billing rule exceptions, or step therapy requirements.

Lists include code mappings and equivalencies (e.g., groups like 26541, 26591 = 26852).
The excerpt represents a partial portion of the full ASC code list.

Billing Rule

ASC code list (no authorization specified)

This excerpt enumerates ASC-approved CPT codes and equivalencies (for example, 43257 mapped to multiple related CPTs) for ASC reimbursement; no prior authorization or other provider action requirements are stated in this section.

Example mapping: 43257 = 43259, 43260, 43261, … 44379.
Some mapped codes in the list are marked with an asterisk indicating exemption from multiple procedure reduction.

Billing Rule

ASC code list excerpt

This excerpt lists ASC-approved procedure codes (CPT and related equivalencies) that are eligible for Ambulatory Surgery Center reimbursement; the provided chunks do not include any explicit prior authorization, documentation, denial, or step therapy instructions.

Example mapping group: 65140 = 65150, 65155, 65175, … 66170.
Some codes in these listings are noted with an asterisk (*) and are exempt from multiple procedure reduction.

Terms and Notations

Asterisked codes (*)

DefinitionCodes marked with an asterisk (*) are exempt from Multiple Procedure Reduction.

Location in documentAsterisked codes are indicated throughout the ASC code list (see chunk 0 and mapping groups where some codes are shown with *).

Billing impactWhen multiple procedures are performed, asterisked codes are not subject to the payer's multiple procedure reduction rules, which can affect payment calculations.

ASC codes — standard approved list (partial)

DefinitionASC codes: Standard Approved Ambulatory Surgery Center (ASC) Codes are procedure codes designated for ASC reimbursement by CareFirst.

Examples (partial)Examples in this excerpt include mappings such as 26541 -> 26852, 27894 -> 28002, and groups around 43257 and 44380–44394.

StatusCodes listed are eligible for reimbursement in an ASC setting; codes not listed are not eligible for payment.

Partial list noteThe presented ASC codes are part of a multi-chunk list and this is not the full enumeration; consult the complete list for full coverage determinations.

ASC‑approved CPT codes (excerpted)

DefinitionASC-approved CPT codes: CPT procedure codes designated by CareFirst for Ambulatory Surgery Center reimbursement as listed in this document.

Representative codes (partial)Sample codes shown include 0213T, 11971*, 12005*, 26541, 43257, 65140 and others across the excerpted chunks.

Mixed code systemsThe list includes CPT, HCPCS and some J-/V- codes in the broader ASC code listings (see chunks 54–59 for examples).

Effective dateCodes in the ASC-approved list are effective as of June 2, 2025.

CareFirst BlueCross BlueShield — organizational name

CareFirst shared business nameCareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc.

Independent entitiesCareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association.

Trademark noticeBLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association.

Policy Summary

PayerCareFirst

PolicyStandard Approved Ambulatory Surgery Center (ASC) Codes

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJune 2, 2025

Next Review DateN/A

Key ActionUse only the procedure codes listed in this document for ASC reimbursement; codes not listed are not eligible for payment.

SourceLink

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