Medicare Policies and Procedures

Medicare Part B ASC Provider Manual

CMS Ambulatory Surgical Centers Website

CMS Surveyor Guidelines

416 Code of Federal Regulations


The Health Care Financing Administration (HCFA) of the Department of Health and Human Services administers the Medicare program. HCFA contracts with the State of Florida Agency for Health Care Administration (AHCA) to survey facilities for compliance with Medicare’s conditions for coverage.

AHCA will send an Ambulatory Surgery Center Request for Certification in the Medicare Program application form when licensure application is requested. Both the application for state licensure and for Medicare certification are returned to AHCA.

The AHCA inspections for state licensure and for Medicare participation are separate but related inspections. AHCA inspects for licensure before the building can be occupied even by center employees and again before the treatment of any patients. After a few patients are served, AHCA will return for the Medicare participation inspection. Usually the same persons perform both the inspection once the building has equipment and supplies in place. The inspection will typically occur after a few patients are treated. While the state licensure survey involves a comprehensive review of policies and procedures, facility, and proposed operational activities, the Medicare certification survey uses the state review as a building block. During the Medicare survey, patient records are reviewed to determine if actual care delivered complied with Medicare requirements and followed policies and procedures that were reviewed during the state licensure inspection.

Medicaid requires that the center be in compliance with Medicare’s conditions for coverage. Once Medicare certification is obtained, the application for Medicaid participation can proceed. Another survey is not performed. Medicaid participation requires an application and confirmation of Medicare certification.


Medicare Part B pays a facility payment to certified ambulatory surgical centers for services listed on Medicare’s ASC coverage list ‑ about 3,300 surgical procedures. Those listed are eligible for a facility payment. (You can find a list of Medicare ASC covered procedures on the CMS website at

The facility payment is designed to cover the ASC’s overhead costs such as supplies, space, administrative and clinical support staff, etc. Physicians who perform surgery at an ASC bill Medicare directly for their professional services.

ASCs are either hospital‑based or freestanding entities that operate exclusively for furnishing outpatient surgical procedures and have entered into an agreement with Medicare to bill and be reimbursed for facility services.