For Dates of Service On and After April 1, 2013, and Before January 1, 2014

Procedures Reimbursable Only as Inpatient Hospital or Ambulatory Surgery Center Services

Effective for DOS on and after April 1, 2013, certain surgical procedures may be reimbursed only when performed in an inpatient hospital, indicated by POS code 21 (Inpatient Hospital), or an ASC, indicated by POS 24 (Ambulatory Surgical Center).

Providers billing these services on professional claims (i.e., the 837P transaction or the 1500 Health Care Claim Form) are affected by this policy.

The following table lists services that may be reimbursed only when performed in an inpatient hospital. This list may be periodically updated.

The following table lists services that may be reimbursed only when performed in an inpatient hospital or ASC. The list may be periodically updated.