Acknowledgement:

Information on reimbursement in the United States is provided as a courtesy. Due to the rapidly changing nature of the law and Medicare payment policy, and our reliance on information provided by outside sources, the information provided herein does not constitute a guarantee or warranty by Smith and Nephew,Inc that reimbursement will be received.

This information is provided "AS IS" and without any other warranty or guarantee, expressed or implied, as to completeness or accuracy or otherwise. This information has been compiled based on data gathered from many primary and secondary sources, including the American Medical Association and certain Medicare contractors.

Physicians and other providers must confirm or clarify coding and coverage from their respective payers, as each payer may have differing formal or informal coding, coverage policies, or decisions. Physicians and providers are responsible for accurate documentation of patient conditions, and for reporting of procedures and products in accordance with particular payer requirements.

Reimbursement


Medicare Payment for Ambulatory Surgery Centers (ASCs)

Please click the plus (+) signs to the left of the topics to learn more.

 

The ASC system is the Medicare prospective payment system for ASC procedures and separately payable products. It applies to all ASCs except for those in Maryland, VA hospitals, and Critical Access hospitals.

Procedures are assigned to ASC groups based on the resources necessary to provide care. Each ASC group has a national payment allowable, which is adjusted according to geographic region and to the particular facility.

At each ASC encounter where OASIS® Matrix products are applied and fully documented (including the method of fixation), the ASC should report the appropriate HCPCS code for the application of “low cost” products. Effective January 1, 2015 Medicare packaged the add-on procedure code and the OASIS® Matrix product into the ASC payment for the procedure.

Dressings and medical supplies are bundled into the ASC payment.

 
 

Below is an overview of the Medicare national average Ambulatory Surgery Center (ASC) payment rates* for HCPCS codes C5271-C5278 when OASIS® Matrix products are applied in ASCs by physicians and when covered by Medicare.

* Payments are nationally unadjusted average amounts and do not account for differences in payment due to geographic variation.

**These rates do not account for the impact of the sequester.

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.html

 
 

The patient is responsible for paying the 20% coinsurance of the Medicare ASC allowable rates and of the Medicare Physician Fee Schedule allowable rate.

The patient's Medicare coinsurance owed to the ASC and to the QHP for the application of OASIS® Matrix products will vary depending on the anatomic location of the wound surface area.

To obtain this quarter's ASC Medicare Payment Information Sheet for OASIS® Matrix products, please download the ASC Medicare Quarterly Payment Information Sheet.

 

OASIS® is a registered trademark of Cook Biotech, Inc.
CPT® is a registered trademark of the American Medical Association.

Private Payers and Medicaid

 

 




©2015 Smith & Nephew, Inc. All rights reserved.
OASIS is a registered trademark of Cook Biotech, Inc.
All trademarks acknowledged. HS1187-0214

Use of this Website is governed by the Terms of Use and Copyright & Disclaimer and Privacy Policy. This Website is intended for healthcare professionals in the United States only. The information provided is for informational purposes only and is not intended to be medical advice. It does not replace the professional training, experience, and knowledge of the healthcare provider responsible for patient care, who must base treatment upon the unique characteristics of each patient.

If you have questions about OASIS® MATRIX products that are not answered by this Website, contact us.