Physicians score victory on Medicare surgicenter coverage

Instead of losing the ability to bill for dozens of procedures in this setting, doctors will be able to charge for many more services.

By David Glendinning, AMNews staff. May 23/30, 2005.

Washington -- Responding to pressure from the American Medical Association and other groups, the Bush administration has backed away from its plan to limit Medicare coverage of procedures at ambulatory surgery centers.

The Centers for Medicare & Medicaid Services prompted outcry last November when it proposed deleting scores of entries from the list of procedures for which Medicare will reimburse in the ASC setting. CMS made a nearly complete reversal after hearing complaints from dozens of physician organizations.

"After strong opposition by the AMA and specialty societies to a CMS proposal to delete 100 procedures from the list of services that Medicare covers in ambulatory surgery centers, CMS recently chose to delete only five codes and add an additional 65 codes to the ASC list," said AMA Chair J. James Rohack, MD. "We are pleased that CMS listened to our concerns and made changes so that Medicare patients' access to certain procedures at ASCs will not be hampered."

Before regulators changed their minds about the plan, physicians were contemplating a situation in which ambulatory surgery centers would be effectively off-limits for Medicare patients requiring such common procedures as prostate biopsies and diagnostic cystoscopies. The administration also had planned to approve only 25 new procedures for coverage but more than doubled the number when physicians complained that the list wasn't large enough.

Led by the AMA and the Federated Ambulatory Surgery Assn., doctors quickly made their voices heard.