CurrentCareFirstPolicy N/A

Standard Approved Ambulatory Surgery Center (ASC) Codes

List of CPT/HCPCS procedure codes that CareFirst approves for reimbursement in an Ambulatory Surgery Center (ASC) setting; 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 DateNov 1, 2019

Next Review DateN/A

Key ActionBill only codes listed for ASC reimbursement; codes not listed are not eligible for payment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2019-11-01effective date for listed codes

marked with *codes exempt from Multiple Procedure Reduction

108covered code count (partial)

20+document chunks

ASC Coverage Criteria

ASC reimbursement stance

ALL of the following

The following list of Standard Approved ASC Codes are approved by CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (CareFirst) and eligible for reimbursement in an ASC setting.
Codes not listed are not eligible for payment.
The codes with an asterisk(*) are exempt from multiple procedure reduction.
These codes are effective as of Nov. 1, 2019.

(See ASC approved code list in coding tables for the complete enumerated codes.)

ASC Code List (partial)

This section provides the standard approved ASC codes and mapping relationships used for ambulatory surgery center billing. Some codes are marked as exempt from multiple procedure reduction.

ALL of the following

Position-based mappings: examples include '26100, 1 = 26433; 26100, 2 = 26561; 26100, 3 = 27035; 26100, 4 = 27325; 26100, 5 = 27428' and many other multi-position mappings.
Entries may be annotated with an asterisk to indicate exemption from Multiple Procedure Reduction (e.g., '26125*' shown in mappings).
Additional multi-position mapping examples appear throughout the mapping list (see coding mapping tables).

(Refer to mapping examples for full positional equivalencies and exemption flags.)

ASC code mappings (partial)

This section enumerates ASC-appropriate CPT codes and positional mappings. Some codes are annotated as exempt from multiple procedure reductions.

ALL of the following

Positional mappings: examples include '43245, 1 = 43887*; 43245, 2 = 45020; 43245, 3 = 45541; 43245, 4 = 46922; 43245, 5 = 49327*'.
Some mapping groups include codes annotated with an asterisk to denote exemption from Multiple Procedure Reduction (see entries such as 43887* and 49327*).
Larger mapping blocks list multiple primary codes with their positional equivalents across five positions (e.g., sequences beginning '36835', '36838', '36861', '36901', etc.).

(See full ASC CPT mapping groups in coding section for complete position-based equivalencies.)

ASC Code Mapping Criteria

Approved ASC code equivalencies and mappings (partial list provided in these chunks).

ALL of the following

Approved equivalencies examples: '64732, 64832* = 64891' and '64774, 64832* = 64912'.
Some mapped entries combine CPT and HCPCS codes (e.g., '69910 = C9745; 69910 = C2638; 69910 = C2639; 69910 = C2640; 69910 = C2641; 69910 = V2785').
Asterisked codes in mappings indicate exemption from Multiple Procedure Reduction (examples: multiple entries with '*').
Additional mappings include series of related codes with positional equivalents and occasional exemption flags across the ophthalmology/related groups (see mapping block).

(This is a partial list; consult the full mapping tables for the complete set of approved ASC code equivalencies.)

Approved ASC Codes and Coding Notes

ASC approved codes (partial list shown)CPTCovered

0191T
0213T
0214T	exempt from multiple procedure reduction
0215T	exempt from multiple procedure reduction
0216T
0217T	exempt from multiple procedure reduction
0218T	exempt from multiple procedure reduction
0228T
0229T	exempt from multiple procedure reduction
0230T

1–10 of 108

1/11

ASC mapping examplesmixed

26100,1	maps to 26433 (example mapping)
26125*	entry marked with * indicating exemption from Multiple Procedure Reduction
43245,1	maps to 43887* (example later-chunk mapping)

ASC CPT mapping groups (partial)CPT

43245	Mapped grouping with position-based equivalents (e.g., 43245,1 = 43887; 43245,2 = 45020; etc.)
43772	Examples of mappings with multiple positions (43772,1 = 44406; 43772,5 = 49570)
64644	Series of ophthalmology/related mappings (64644, 64645*, etc.)

Approved ASC code mappings (partial)mixed

64732, 64832* = 64891	Example mapping showing approved ASC code equivalency; asterisk denotes exempt from multiple procedure reduction where noted.
64774, 64832* = 64912	Example mapping entry.
69320 = 69421	Example mapping entry.
69910 = C9745	Example mapping linking CPT to HCPCS code.

inv-09: effective_date

Policy effective date2019-11-01

Document note on timingThese codes are effective as of Nov. 1, 2019.

Applies toCareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc.

inv-10: Multiple Procedure Reduction exemption

Exemption notationSome listed codes are marked with an asterisk (*) to denote exemption from Multiple Procedure Reduction.

Examples in code listCodes such as 0214T*, 0215T*, 10004*, 11045*, and many others are shown with an asterisk in the ASC code list.

Mapping sections also flag exemptionsPositional mapping entries across chunks (e.g., chunks 36 and 41) include entries followed by an asterisk to indicate exemption.

Billing & Provider Notes

Billing Rule

Approved ASC codes and payment eligibility

The following list of Standard Approved ASC Codes are approved by CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (CareFirst) and eligible for reimbursement in an ASC setting. Codes not listed are not eligible for payment. The codes with an asterisk(*) are exempt from multiple procedure reduction. These codes are effective as of Nov. 1, 2019.

0191T
0213T
0214T*
0215T*
0216T
0217T*
0218T*
0228T
0229T*
0230T
0231T*
0234T
0235T
0236T
0237T
0238T
0419T
0420T
10004*
10005
10006*
10007
10008*
10009
10010*
10011
10012*
10021
10035*
10036*
10121
10180
11010
11011
11012
11042
11043
11044
11045*
11046*
11047*
11400
11401
11402
11403
11404
11406
11420
11421
11422
11423
11424
11426
11440
11441
11442
11443
11444
11446
11450
11451
11462
11463
11470
11471
11604
11606
11623
11624
11626
11644
11646
11770
11771
11772
11921
11960
11970
11971*
12005*
12006*
12020
12021
12034
12035
12036
12037
12044
12045
12046
12047
12051
12052
12053
12054*
12055
12056*
12057
13100
13101
13102*
13120
13121
13122*
13131
13132
13133*
13151

Billing Rule

ASC Code mappings and notes

Lists standardized ASC code mappings and notes on exemptions. The mapping format below indicates code groupings and equivalencies used for billing and multiple-procedure considerations. Where an asterisk appears next to a code it indicates exemption from multiple procedure reduction.

26080, 5 = 27427
26100, 1 = 26433
26100, 2 = 26561
26100, 3 = 27035
26100, 4 = 27325
26100, 5 = 27428
26105, 1 = 26434
26105, 2 = 26562
26105, 3 = 27040
26105, 4 = 27326
26105, 5 = 27429
26110, 1 = 26437
26110, 2 = 26565
26110, 3 = 27041
26110, 4 = 27327
26110, 5 = 27430
26111, 1 = 26440

Billing Rule

ASC code list (partial)

Continues ASC code mapping list with multiple-procedure exemption note. Mapping entries show primary codes with positional equals indicating related procedure code equivalencies across groups. The asterisked codes are exempt from multiple procedure reduction.

40654
36835, 3 = 42140
36835, 4 = 42835
36835, 5 = 43240
36838, 1 = 37619
36838, 2 = 40700
36838, 3 = 42145
36838, 4 = 42836
36838, 5 = 43241
36861, 1 = 37700
36861, 2 = 40702
36861, 3 = 42182
36861, 4 = 42844
36861, 5 = 43243
36901, 1 = 37718
36901, 2 = 40720
36901, 3 = 42200

Billing Rule

ASC Code Equivalencies

Mapping/list of approved ASC procedure code equivalencies for billing. Shows direct equivalencies where one or more CPT codes map to a preferred ASC code for billing purposes; includes notes where specific codes are exempt from multiple procedure reduction (marked with *).

67914 = 68328
64732, 64832* = 64891
64732, 65265 = 65779*
64732, 66185 = 66830
64732, 67141 = 67405
64732, 67914 = 68330
64734, 64832* = 64892
64734, 65265 = 65780
64734, 66185 = 66840
64734, 67141 = 67412
64734, 67914 = 68335
64736, 64832* = 64893
64736, 65265 = 65781
64736, 66185 = 66850
64736, 67141 = 67413
64736, 67914 = 68340

Key Definitions

inv-15: Exempt from Multiple Procedure Reduction

Definition termExempt from Multiple Procedure Reduction

Short form in documentThe document includes the phrase 'Exempt from Multiple Procedure Reduction' as a definition label in headings/notes.

Where shownAppears in definition/notes lines following code lists and mappings (e.g., chunks 15, 20, 57).

inv-16: Exempt from Multiple Procedure Reduction

Asterisk notation meaningAn asterisk (*) following a code indicates that the code is exempt from Multiple Procedure Reduction.

Document statementThe codes with an asterisk(*) are exempt from multiple procedure reduction.

Mapping examplesMapping lines and code lists include '* Exempt from Multiple Procedure Reduction.' statements in multiple chunks.

inv-17: Exempt (*)

Exempt (*) — short definition* Exempt from Multiple Procedure Reduction.

UsageUsed inline with codes in code mappings and lists to indicate exemption status.

Examples in mappingsSeveral positional mappings show entries with '*' (e.g., entries in chunks 36, 41, 57).

inv-18: Exempt from Multiple Procedure Reduction

Asterisk indicates exemptionAn asterisk (*) indicates codes exempt from Multiple Procedure Reduction.

PlacementThe asterisk appears directly after specific codes in both the ASC code list and mapping equivalencies.

Document confirmationThe code list explicitly states 'The codes with an asterisk(*) are exempt from multiple procedure reduction.'

Policy Summary

PayerCareFirst

PolicyStandard Approved Ambulatory Surgery Center (ASC) Codes

Policy CodePolicy N/A

Change TypeNo material change

Effective DateNov 1, 2019

Next Review DateN/A

Key ActionBill only codes listed for ASC reimbursement; codes not listed are not eligible for payment.

SourceLink

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