(Manual Name)

Group Code: CO  CARC: 4  RARC: N/A  MSN: 16.2  Contractors shall deny separately billed implantable devices.   The contractor shall use the followi ng remittance advice messages and associated codes when rejecting/denying claims under this policy.  This CARC/RARC combination is compliant with CAQH CORE Business Scenario Four.  Group Code: CO  CARC: 97  RARC: M97  MSN: 16.32  If there is a related, approv ed surgical procedure for the billing ASC for the same date of service, also include the following MSN message: 16.8.  60.3  Applicable ASC Messages for Certain Payment Indicators Effective for Services Performed on or after January 1, 2009 (Rev. 11793; Issued:01 -19-23; Effective: 02 -21-23; Implementation: 02 -21-23)  Contractors shall deny services for HCPCS codes with payment indicators C5  (Inpatient surgical procedure under the OPPS; no payment made.), M6 (No payment made; paid under another fee schedul e), U5 (Surgical unlisted service excluded from ASC payment.  No payment made.), or X5 (Unsafe surgical procedure in ASC.  No payment made).   The contractor shall use the following remittance advice messages and associated codes when rejecting/denying clai ms under this policy.  This CARC/RARC combination is compliant with CAQH CORE Business Scenario Four.  Group Code: CO  CARC: 5  RARC: N/A  MSN: 16.32  Contractors shall deny services for CPT codes with payment indicators E5 (Surgical procedure/item not valid for Medicare purposes because of coverage, regulation and/or statute; no payment made), or Y5 (Non -surgical procedure/item not valid for Medicare purposes because of coverage, regulation and/or statute; no payment made).   The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy.  This CARC/RARC combination is compliant with CAQH CORE Business Scenario Three.   Group Code: PR  CARC: 96  RARC: N425  MSN: 16.10  NOTE:   Contractors shall assign beneficiary liability for facility charges HCPCS codes billed with ASC payment indicators C5, E5, U5 and X5 .  Contractors return as unprocessable services for HCPCS codes with payment indicator D5 (Deleted/discontinued code; no p ayment made).   The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy.  This CARC/RARC combination is compliant with CAQH CORE Business Scenario Two.   Group Code: CO  CARC: 181  RARC: N56  MSN: N/A  Contractors shall deny services for HCPCS with payment indicators L1  (Influenza vaccine; pneumococcal vaccine, Covid -19 Vaccine, monoclonal antibody therapy product.  Packaged item/service; no separate payment made), NI (Packaged service/item; no separate payment made) or  S1 (Service not surgical in nature; and not a radiology service payable under the OPPS, drug/biological, or brachytherapy source.  Packaged item/service; no separate payment made).   The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy.  This CARC/RARC combination is compliant with CAQH CORE Business Scenario Four.  Group Code: CO  CARC: 97  RARC: N390  MSN: 16.32  Contractors shall return as unprocessable services for HCPCS with payment indicators B5 (Alternative code may be available; no payment made).  The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy.  This  CARC/RARC combination is compliant with CAQH CORE Business Scenario Two.   Group Code: CO  CARC: 16  RARC: M51  MSN: N/A  70 - Ambulatory Surgical Center (ASC) HCPCS Additions, Deletions, and Master Listing (Rev. 11793; Issued:01- 19-23; Effective: 02 -21-23; I mplementation: 02 -21-23)  Prior to January 1, 2018, the CMS Division of Data Systems (DDS) releases the ASC HCPCS, additions, deletions, and master listing files of ASC codes on a periodic basis.  Instructions on how to retrieve these files from the CMS ma inframe telecommunications system are also published on the same periodic basis.  The Office of Information Services (OIS) announces the dates that the files are available.  Beginning January 1, 2008, the CMS Division of Data Systems (DDS) releases the ASCF S, ASC Drug File, ASC Restated Drug Files, ASC PI file, and the ASC Code Pair file, as appropriate.  Instructions on how to retrieve these files from the CMS mainframe are communicated at the time that the files are released.  The ASC payment system quarte rly recurring update notifications also identify the files that are applicable to that quarters update of the payment system.      Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R11927CP  03/24/2023  April 2023 Update of the Ambulatory Surgical Center [ASC] Payment System  04/03/2023  13143  R11903CP  03/16/2023  April 2023 Update of the Ambulatory Surgical Center [ASC] Payment System -- Rescinded and replaced by Transmittal  11927  04/03/2023  13143  R11793CP  01/19/2023  Internet -Only Manual [IOM] Updates for Ambulatory Surgical Centers [ASCs]  02/21/2023  13067  R3939CP  12/22/2017  January 2018 Update of the Ambulatory Surgical Center (ASC) Payment System  01/02/2018  10441  R3650CP  11/10/2016  Updates to Pub. 100- 04, Chapters 8, 13 and 14 to Correct Remittance Advice Messages 02/10/2016  9841 R3430CP  12/29/2015  January 2016 Update of the Ambulatory Surgical Center (ASC) Payment System  01/04/2016  9484 R3031CP  08/22/2014  Update to Pub. 100- 04, Chapter 14 to Provide Language -Only Changes for Updating ASC X12 09/23/2014  8768 R2020CP  08/06/2010  Clarification of Billing Requirement for Ancillary Services Performed in the Ambulatory Surgical Center (ASC) by Entities Other Than A SCs 09/07/2010  7078 R1865CP  12/01/2009  January 2010 Update of the Ambulatory Surgical Center (ASC) Payment System  01/04/2010  6746 R1698CP  03/13/2009  April 2009 Update to the ASC Payment System; Summary of Payment Policy Changes/Manual Revisions  04/06/2009  6424 R1669CP  01/13/2009  January 2009 Update of the Ambulatory Surgical Center (ASC) Payment System  01/05/2009  6323 Rev #  Issue Date  Subject  Impl Date  CR#  R1616CP  10/17/2008  Implementation of an ASC HCPCS Payment Indicator File  01/05/2009  6184 R1572CP  08/08/2008  New Requirement for Ordering/Referring Information on Ambulatory Surgical Center (ASC) Claims for Diagnostic Services  01/05/2009  6129 R1514CP  05/23/2008  ASC Manualization  06/23/2008  6031 R1325CP  08/29/2007  Testing and Implementation of 2008 Ambulatory Surgical Center (ASC) Payment System Changes  01/07/2008  5680 R1308CP  07/20/2007  Testing and Implementation of 2008 Ambulatory Surgical Center (ASC) Payment System Changes (Sensitive and Controversial)  Replaced by Transmittal 1325  01/07/2008  5680 R1160CP  01/19/2007  Colorectal Cancer Screening Flexible Sigmoidoscopy and Colonoscopy Coinsurance Payment Change  07/02/2007  5387 R975CP  06/09/2006  Ambulatory Surgical Center (ASC) Claims Processing Manual Clarification  06/05/2006  5026 R942CP  05/05/2006  Ambulatory Surgical Center (ASC) Claims Processing Manual Clarification  10/02/2006  5026 R914CP  04/21/2006  Additional $50 Payment for New Technology Intraocular Lenses Furnished In Ambulatory Surgical Centers  05/22/2006  4361 R639CP  08/05/2005  Cessation of Additional $50 Payment for New Technology Intraocular Lenses (NTIOLs)  10/03/2005  3901 R001CP  10/01/2003  Initial Publication of Manual  NA NA Back to top of Chapter