Medicare Payment Resources

The Centers for Medicare & Medicaid Services (CMS) uses a network of contractors called Medicare Administrative Contractors (MACs) to process Medicare claims, enroll healthcare providers in the Medicare program and educate providers on Medicare billing requirements. MACs also handle claims appeals and answer beneficiary and provider inquiries. Find your MAC.

Medicare pays ASCs a prospectively determined rate for covered procedures. These rates are updated annually via a regular process. Each summer, Medicare proposes rates for the next year and then finalizes the rates in the fall.

CMS maintains a comprehensive resource document, the Medicare Claims Processing Manual that contains definitions, policies, and processes relating to submitting a claim for procedures performed in an ASC.

2025 Final Payment Rule

2025 Final Payment Rule

The Centers for Medicare & Medicaid Services (CMS) released the 2025 final payment rule for ASCs and hospital outpatient departments (HOPD).

2025 Final Rule Analysis

This document identifies and briefly summarizes provisions of greatest interest to ASCA in Medicare's 2025 OPPS/ASC Payment System final rule.

2025 Final Rule Rate Calculator

This calculator shows 2025 national and local ASC payment rates as published in the Centers for Medicare & Medicaid Services (CMS) CY 2025 OPPS/ASC final rule.

Please note the following features of the rate calculator, which has changed slightly in the past year:

  • All codes are now included on the calculator. Please reference the "PI Definition" column for codes without a listed payment rate.
  • The calculator now displays the following national and locally adjusted rates:
    • Total payment (before and after sequestration)
    • Medicare payment (before and after sequestration)
    • The 2% sequester amount
    • The beneficiary copayment (which is not affected by the sequester).
  • The calculator allows users to format cells, columns and rows without affecting the calculator, UNLESS the columns with the state and county selector are hidden.
  • There are 15 columns located to the right of the calendar (highlighted in yellow) that are unlocked, should you wish to add custom filters, formulas or other adjustments.
  • Every column now includes a filter. The new and revised code column has also been altered to allow users to filter for new or revised codes specifically.

Please contact Alex Taira with any questions.

2025 Final Rule Payment Resources

This workbook breaks out the codes on the 2025 ASC Covered Procedures List (ASC-CPL) into groups, such as separately payable, office-based, device-intensive and more.

2025 Proposed Payment Rule

2025 Proposed Payment Rule

The Centers for Medicare & Medicaid Services (CMS) released the 2025 proposed payment rule for ASCs and hospital outpatient departments (HOPD).

2025 Proposed Rule Analysis

This document identifies and briefly summarizes provisions of greatest interest to ASCA in Medicare's 2025 OPPS/ASC Payment System proposed rule.

2025 Proposed Rule Comment Letter

These formal comments were submitted by ASCA in response to the CY 2025 OPPS/ASC proposed rule. ASCA also submitted comments in response to the CY 2025 Medicare Physician Fee Schedule (MPFS) proposed rule.

2025 Proposed Rule Rate Calculator

This calculator shows proposed 2025 national and local ASC payment rates as published in the Centers for Medicare & Medicaid Services (CMS) CY 2025 OPPS/ASC Proposed Rule.

2025 Proposed Rule Payment Resources

This workbook breaks out the codes on the proposed 2025 ASC Covered Procedures List (ASC-CPL) into groups, such as separately payable, office-based, device-intensive and more.

While there is no substitute for receiving a legal opinion regarding the specific facts in a particular case from qualified counsel that practice in this specialized area of law, the Federal Regulations section of ASCA’s website provides a starting point for understanding the federal rules impacting ASCs. For questions or more information, contact Kara Newbury at knewbury@ascassociation.org.
Reproduction in whole or in part without written permission from ASCA is prohibited.

Facility Fee

Payors, including Medicare, reimburse facilities such as ASCs separately from physicians. The facility reimbursement is called the “technical component,” whereas physicians are reimbursed via a payment called the “professional component.” The technical component is also called the facility fee and pays for services such as nursing, technicians, administrative services, etc.

Learn More