CurrentCareFirstPolicy N/A

Standard Approved Ambulatory Surgery Center (ASC) Codes

List of CPT procedure codes that CareFirst approves as payable 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 DateJan 1, 2022

Next Review DateN/A

Key ActionUse the listed CPT codes for ASC reimbursement; codes not on the list are not eligible for payment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2022-01-01codes effective

20+ pagesdocument length

asteriskexemptions

NCapplicable state

ASC Coverage Criteria

ASC Payment Eligibility Criteria

Coverage stance based on inclusion in the list:

Policy Summary

PayerCareFirst

PolicyStandard Approved Ambulatory Surgery Center (ASC) Codes

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2022

Next Review DateN/A

Key ActionUse the listed CPT codes for ASC reimbursement; codes not on the list are not eligible for payment.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

ASC-approved code listings (partial)

This section of the policy provides the approved CPT codes and code-to-code equivalencies for ASC settings. It does not include explicit clinical indications or prior authorization requirements in the provided excerpts.

The policy lists approved CPT codes and many code-to-code equivalencies (e.g., '28415 = 28525'; '27442, 27612 = 27632').

Presence of a mapping or equivalency in the list indicates the codes or combinations are recognized for ASC reimbursement by CareFirst.

Approved ASC code combinations

The document defines which code combinations are 'standard approved' for ASC billing; presence in the list indicates the combination is recognized for ASC reimbursement.

ALL of the following

An asterisk on mapped codes denotes a special annotation (see annotations block) and may indicate exemption from multiple procedure reduction.

These standard approved combinations should be used for reimbursement adjudication in ASC claims when the codes correspond to the services performed.

Approved ASC Codes and Annotations (partial)

This section provides approved ASC code mappings and notes for billing; codes listed are recognized by CareFirst for ASC reimbursement with specific annotations where applicable.

The policy lists extensive code mappings and annotations; examples include multi-code equivalencies (e.g., '62361 = 62362', '62361 = 63001', repeated mappings across the list).

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

Codes shown as 'codeA, codeB = codeC' indicate an approved mapping or paired relationship for ASC billing (examples seen throughout the list such as '66985, 67316 = 67318' and many others).

Approved Codes and Coding Notes

Covered ASC Codes (excerpt)CPTCovered

10004
10005
10006
10007
10008
10009
10010
10011
10012
10021

1–10 of 61

1/7

Covered Mapped CPT ExamplesCPTCovered

27442, 27612 = 27632	Example mapping showing paired codes / equivalency
27442, 27730 = 27766	Example mapping showing paired codes / equivalency

Neutral Mapped CPT ExamplesCPT

43195, 44385 = 45305	example mapped CPT code (neutral)
43196, 44385 = 45307	example mapped CPT code (neutral)

Selected ASC code pairings (excerpt)CPTCovered

66985, 67316 = 67318
66985, 67903 = 67904
66985, 68510 = 68520

Modifier / AnnotationModifier

V2785

Listed as a mapping target in ASC codes

Coding notes

Multiple Procedure Reduction ExemptionCodes with an asterisk (*) are exempt from Multiple Procedure Reduction. See full list in document.

Repetition / Multiple EquivalenciesSome codes (e.g., 62361, 64417) are listed with many equivalencies in the document — see full list in document.

Multiple Procedure Reduction NoteCodes marked with '*' are exempt from Multiple Procedure Reduction. See full list in document.

Billing and Provider Instructions

Billing Rule

Payment eligibility list — no authorization rules in this excerpt

The document provides CareFirst’s approved code list for Ambulatory Surgery Center (ASC) reimbursement and states that codes not listed are not eligible for payment; no prior authorization, documentation, step therapy, or explicit denial-risk instructions are included in this excerpt.

Codes not listed are not eligible for payment.
Codes with an asterisk (*) are exempt from multiple procedure reduction.
Codes effective as of January 1, 2022.

Billing Rule

ASC code list (partial)

This section lists approved ASC CPT procedure codes and numerous code-to-code equivalencies (pairings/replacements) for ASC billing; the excerpt does not include prior authorization, documentation, denial-risk, or step therapy instructions.

Examples of equivalencies shown: “28415 = 28525” and many mappings where one code is listed equal to another or to a paired combination.
The list is presented as approved mappings for ASC reimbursement adjudication.

Billing Rule

ASC code mapping (excerpts)

The policy lists ASC code mappings and approved code combinations used for reimbursement adjudication; these mappings indicate which code pairs or replacements CareFirst recognizes for ASC payment.

Examples include mappings such as “43204, 43220 = 43273*” and many sequential code pairings used to determine allowable combinations.
Asterisked mappings indicate special annotation (e.g., exemption from multiple procedure reduction).

Billing Rule

Approved ASC Code List (partial)

This section provides approved ASC CPT/HCPCS code pairings and equivalents for billing and reimbursement; many entries show a primary code paired with an approved equivalent or replacement code.

Examples include “66985, 67316 = 67318” and multiple lines where one code maps to another (some with * annotations).
Asterisked codes (e.g., 66989*, 66991*) indicate exemption from multiple procedure reduction as noted in the list.

Key Definitions and Notes

inv-17: Exempt from Multiple Procedure Reduction

DefinitionCodes marked with an asterisk (*) are exempt from multiple procedure reduction.

Document noteThe codes with an asterisk(*) are exempt from multiple procedure reduction — explicit statement at top of list.

Example codes with '*'10004*, 10006*, 10008*, 10010*, 10035*, 10036* (examples from the ASC list).

inv-18: ASC code mappings

PurposeProvides Standard Approved Ambulatory Surgery Center (ASC) code mappings and equivalencies for ASC reimbursement.

Example mapping formatEntries show one-to-one or paired mappings (e.g., 43195, 44385 = 45305; 27442, 27612 = 27632).

UseThese mappings indicate approved combinations/equivalencies for ASC billing adjudication.

inv-19: Mapping of CPT/HCPCS codes indicating approved combinations or equivalencies for ASC reimbursement

Mapping conventionCodes are presented as equivalencies or approved pairings using '=' and comma-separated lists (e.g., '27442, 27612 = 27632'; '67227, 68510 = 69501').

Representative pairs28415 = 28525; 43204, 43220 = 43273*; 67227, 69552 = 69706.

Implication for billingListed combinations are recognized by CareFirst for ASC reimbursement; presence in the list denotes eligibility in ASC setting.

inv-20: '*' — Exempt from Multiple Procedure Reduction

Annotation meaning'*' denotes exemption from Multiple Procedure Reduction.

PlacementAsterisk appears inline with mapped codes (e.g., 43273*) and in the list footer where the exemption is restated.

Billing effectCodes annotated with '*' should not be subject to multiple procedure payment reductions when billed in the ASC context per this list.