ASC Billing Services
ASC Billing Services That Maximize Your Facility's Revenue on Every Case
Ambulatory surgery center billing operates under a completely different payment framework than physician billing: ASC facility fees are reimbursed through APC-based payment groups, implant and device costs are reported separately, certain procedures are not covered in the ASC setting, and the facility claim must reconcile with the operating surgeon's professional fee claim on every case. A single procedure code error on the facility claim can collapse reimbursement across the entire case. ProtoMed's certified ASC billing specialists protect every case from denial and underpayment. Fewer denials. Faster reimbursements. More revenue.
98%+
Clean Claim Rate
We review every ASC case before submission, catching APC grouping errors, missing device pass-through reporting, blocked procedure filings, prior authorization gaps, and physician-facility claim mismatches.
Why Choose ProtoMed
Stop Losing ASC Revenue to Facility Fee Errors and Implant Billing Gaps
ASC billing is fundamentally different from physician office billing in ways that create consistent, costly errors when billing teams lack ASC-specific expertise. The facility claim (billed on a UB-04) is paid under Medicare's ASC payment system, a flat facility fee determined by APC grouping, not the physician fee schedule. When a procedure is coded incorrectly on the facility claim, the APC group changes and so does the payment rate. When an implant or device passes Medicare's cost threshold, it must be reported separately with a device-intensive procedure indicator to trigger the pass-through payment, and missing that reporting means thousands of dollars in device cost go unrecovered. When a physician bills a procedure that Medicare has designated as inpatient-only or not covered in the ASC setting, the facility claim is denied entirely.
ProtoMed's certified ASC billing team understands the full complexity of ambulatory surgery center revenue cycle management: APC-based facility fee billing, device and implant pass-through reporting, covered versus blocked procedure verification, prior authorization for elective surgical cases, and the coordination between facility claims and operating surgeon professional fee claims. We submit clean facility claims, recover device cost reporting revenue, and follow up on every denial so your ASC collects what it has earned.
Certified ASC Billing Specialists
Every biller on your account holds active AAPC and AHIMA credentials with hands-on experience in ASC facility fee coding, APC grouping, implant and device reporting, blocked procedure verification, and UB-04 facility claim submission.
98%+ Clean Claim Rate
We review every ASC case before submission, catching APC grouping errors, missing device pass-through reporting, blocked procedure filings, prior authorization gaps, and physician-facility claim mismatches.
Zero-Friction Access
We securely log into your existing ASC management system and EHR, with zero disruption to your OR scheduling or case flow.
End-to-End Claims Management
From pre-surgical prior authorization and eligibility verification to facility claim submission, device cost reporting, denial appeals, and payment posting, we manage your complete ASC billing cycle.
Proactive Denial Management
Every rejected claim is investigated, corrected, and resubmitted. We recover ASC facility revenue lost to APC coding errors, missed device pass-through claims, and blocked procedure denials.
Transparent Financial Reporting
Monthly reports and real-time billing data give you a clear picture of your revenue per case, APC payment rates, device cost recovery, denial patterns, and overall ASC financial performance by payer.
Coding Expertise
ASC Coding Expertise That Reduces Denials
ASC billing spans facility fee coding on UB-04 claims, APC-based payment grouping, device and implant reporting, prior authorization management, and coordination with surgeon professional fee claims, each with distinct coding requirements, coverage verification steps, and payer-specific documentation standards. Our certified ASC billers know every code and billing rule across the full ASC facility revenue spectrum.
UB-04 / Revenue Codes
ASC facility claims: revenue code selection (36X, 49X, 71X) with type of bill 83X designation.
APC Groups
Ambulatory Payment Classification: procedure-specific payment groups determining facility fee rates.
HCPCS C1700–C9999
Device and implant reporting: pass-through device codes with cost threshold documentation.
CPT + Modifier -SG
ASC-specific procedure coding: facility indicator modifier for Medicare ASC claims.
Inpatient-Only List
CMS blocked procedure verification: procedures designated inpatient-only not payable in ASC.
Prior Authorization
Pre-surgical authorization: elective procedure approval with payer-specific criteria management.
FL 44 / FL 67
Principal procedure and diagnosis coding: UB-04 field requirements for ASC facility claims.
Specialized Billing Services
Specialized Billing for Every ASC Service
Each ASC billing component carries its own APC grouping impact, device reporting requirement, or coverage verification step. ProtoMed's certified team handles every aspect of ASC facility billing correctly, maximizing reimbursement on every case, recovering device costs, and preventing denials on blocked or unauthorized procedures.
ASC Facility Fee Billing & APC Grouping
The ASC facility fee is determined by APC grouping, a payment classification system where the procedure code drives the payment rate. The same CPT code entered incorrectly, or with a modifier that changes its APC group, can reduce the facility payment by hundreds of dollars per case. Multiple procedures in the same case follow specific APC packaging rules where secondary procedures may be fully packaged into the primary rate. We accurately code every ASC facility claim to maximize the APC assignment and capture the full facility fee your center has earned.
Device & Implant Pass-Through Billing
When the cost of an implantable device or supply used in an ASC case exceeds Medicare's cost threshold, that device qualifies for a separate pass-through payment reported with a HCPCS device code. Missing device pass-through reporting on high-cost implants, cardiac leads, orthopedic implants, neurostimulator components, represents device costs that your ASC paid but never recovered. We identify every device pass-through opportunity on every eligible case and submit device cost claims with the documentation required for full reimbursement.
Blocked Procedure & ASC Coverage Verification
CMS maintains an inpatient-only procedure list: surgical procedures designated as requiring inpatient admission that are not covered when performed in an ASC. When a surgeon schedules an inpatient-only procedure in your ASC, the facility claim will be denied regardless of surgical quality. We verify every scheduled procedure against the current CMS inpatient-only list, identify coverage restrictions before the case date, and flag potential denials before the case is performed, protecting your ASC from non-recoverable facility claim denials.
Prior Authorization & Pre-Surgical Verification
Most commercial payers require prior authorization for elective ASC cases, and a missing authorization means the facility claim is denied entirely regardless of the surgery's quality. We manage prior authorization for all scheduled elective procedures, verify payer-specific ASC coverage and benefit levels, confirm patient deductible and cost-sharing status, and obtain written authorization confirmation before every case. Authorization management is the most cost-effective revenue protection service in ASC billing.
Physician-Facility Claim Coordination
Every ASC case generates two claims: the facility claim (UB-04) submitted by the ASC and the professional fee claim (CMS-1500) submitted by the operating surgeon. Payers cross-reference these claims and deny facility claims where the procedure codes do not match or where the operating date conflicts. We coordinate professional fee and facility claim coding to ensure claim parity on every case, prevent cross-claim denial triggers, and manage the billing interface between your ASC and the surgeons who use your facility.
Anesthesia & Ancillary Service Billing
ASC cases typically involve separate anesthesia billing by an independent anesthesia group or CRNA, as well as ancillary services, pathology, radiology, and laboratory, that may be billed by the ASC or by independent providers. We coordinate anesthesia billing to prevent duplicate facility and professional fee conflicts, manage ancillary service billing within the facility claim when applicable, and ensure the complete revenue picture of each case is captured without duplication or gap.
Our Process
How ProtoMed's ASC Billing Process Works
A structured four-step process that maximizes facility revenue on every surgical case, from pre-surgical coverage verification and prior authorization through APC-optimized facility claim submission and device cost recovery.
Case Review, Coverage Verification & Blocked Procedure Check
Before every scheduled case, we verify patient coverage and ASC-specific benefits, confirm the procedure is not on the CMS inpatient-only list, obtain prior authorization for elective procedures, and identify any device pass-through opportunities. Catching coverage and authorization gaps before the case date eliminates the most preventable and costly ASC facility claim denials.
Pre-Authorization Management & Device Cost Documentation
We submit prior authorization requests with payer-specific clinical documentation, track approval timelines, and confirm written authorization before every elective case. For cases involving high-cost implants or devices, we document device acquisition costs and identify pass-through reporting eligibility to ensure device costs are recovered.
Facility Claim Coding, APC Optimization & UB-04 Submission
Our certified ASC billers code every facility claim on the UB-04 with the correct revenue codes, CPT procedures, and APC-optimized packaging, report device pass-through claims, and scrub each claim against payer-specific requirements and the physician professional fee claim before submission. Facility claims are submitted electronically on time to Medicare, Medicaid, and all major commercial payers.
Denial Management, Payment Posting & Reporting
Every denied claim is investigated and appealed with the clinical and administrative documentation required for reversal, including authorization evidence, device cost documentation, and medical necessity support for challenged cases. Payments are posted accurately and you receive clear monthly reports on your revenue per case, APC payment rates, device cost recovery, and denial patterns by payer and procedure.
Ready to Maximize Your ASC's Facility Revenue on Every Case?
Let ProtoMed's certified ASC billing specialists handle your complete facility revenue cycle, from blocked procedure verification and prior authorization management to APC-optimized facility claim coding, device pass-through reporting, physician-facility claim coordination, and denial appeals. We'll audit your current billing, identify where your ASC facility revenue is being lost, and start recovering it.
Get your free ASC billing audit today. A ProtoMed expert will reach out within 24 hours.