ASC Billing Services
ASC billing services are facility-side billing and revenue cycle services built for ambulatory surgery centers where the surgeon's claim and the center's claim are two completely different things, and getting the facility side wrong means the center performs the case and absorbs the cost. EverCure Billing handles the full facility revenue cycle for ambulatory surgery centers across the United States: benefit verification and prior authorization, facility coding against the ASC Covered Procedures List, implant and device billing, claim submission on the correct form for each payer, denial appeals, and aged A/R recovery. Your surgeons and staff run the schedule. We make sure the center gets paid for every case on it.
What Are ASC Billing Services?
ASC billing services cover the facility claim the ambulatory surgery center's charge for the room, staff, supplies, implants, and recovery care associated with a surgical case.
That is a separate claim from the surgeon's professional fee and separate again from the anesthesia group's claim. Same patient, same procedure, same day, three different bills, three different sets of rules. Most billing companies understand the professional side. Far fewer understand the facility side.
ASC facility billing means confirming the procedure is payable in the ASC setting at all, applying the correct payment indicator and packaging rules, capturing implants and separately payable items, using place of service 24, submitting on the form that specific payer requires, and defending the claim when it denies.
Why Do Ambulatory Surgery Centers Lose Revenue?
ASC denials aren't random they trace back to a small set of rules that are unique to the facility side of surgical billing:
The ASC Covered Procedures List changes
CMS updates the ASC Covered Procedures List and its payment rates on a recurring schedule. A procedure that wasn't payable in the ASC setting last year may be payable now, and a rate you priced against six months ago may no longer be current. Centers routinely under-schedule payable cases or misprice the ones they do perform.
Packaging and payment indicator rules
Under the ASC payment system, many items and services are packaged into the primary procedure payment rather than paid separately. Billing a packaged item as separately payable causes denials. Failing to bill something that is separately payable costs the center real money on every case.
Device-intensive procedures and implants
Device-intensive procedures carry a device portion inside the payment rate, and payer contracts often include implant carve-outs above a dollar threshold. If invoices aren't attached and the carve-out isn't claimed, the center eats the device cost on a case it just performed.
Discontinued procedures billed incorrectly
Modifiers 73 and 74 exist specifically for the facility setting a case discontinued before anesthesia versus after anesthesia is administered. Using modifier 52 or nothing at all on a discontinued case is a straightforward revenue loss on work the center already staffed and supplied.
Multiple procedure reduction
When several procedures are performed in one session, the ASC payment methodology reduces payment on secondary procedures. Sequencing them incorrectly means the center gets the reduced rate on the higher-value procedure.
Prior authorization on high-cost cases
Spine procedures, joint replacements moving into the ASC setting, and many pain and GI procedures require authorization. The authorization frequently sits with the surgeon's office, but the denial lands on the facility claim.
Out-of-network exposure and the No Surprises Act
ASCs carry more out-of-network exposure than most facility types. Good faith estimates, patient notice and consent requirements, and independent dispute resolution timelines all carry hard deadlines. Missing one converts a collectible balance into a write-off.
Documentation that doesn't tie together
The facility claim has to align with the operative report, anesthesia record, implant log, and recovery documentation. When those don't match, the claim is indefensible on audit even if the coding was correct.
We build the facility billing workflow around these eight failure points, because that's where ASC revenue actually disappears.
What ASC Billing Services Does
EverCure Billing Provide?
Eligibility, benefits, and financial clearance
Coverage, plan type, facility benefits, deductible and out-of-pocket status, and network status confirmed before the case is scheduled including patient responsibility estimates so the front desk can collect upfront instead of chasing later.
Prior authorization and pre-certification
Authorization requests submitted and tracked for the facility side, coordinated with the surgeon's office so the auth on file actually covers the procedure and CPT that gets performed, with expiry dates monitored against the schedule.
ASC facility coding
CPT, ICD-10-CM, and HCPCS coding from the operative report with correct laterality, approach, and modifier assignment validated against the current ASC Covered Procedures List and payment indicator before the claim is built.
Implant, device, and supply billing
Device-intensive procedure handling, implant carve-out claims with invoice documentation attached, and separately payable drugs and supplies captured on every applicable case.
Charge capture and reconciliation against the schedule
Every case on the surgical schedule is reconciled against a submitted claim. Cases that were performed but never billed are one of the most common and most expensive gaps we find in ASC audits.
Claim submission on the correct form
Medicare ASC claims are submitted on the CMS-1500 with place of service 24. Some commercial and state payers require a UB-04 facility claim instead. We submit on the form each payer actually accepts, not a single default.
Claim scrubbing and edit review
Pre-submission checks against NCCI bundling pairs, MUE limits, modifier logic including 59, XE, XS, XU, 73, and 74, and payer-specific facility edits.
Payment posting and contract verification
ERA and manual posting with allowance verification against your negotiated facility rates and implant carve-out terms because ASC contracts are complex and underpayments hide easily.
Denial management and appeals
Every denial categorized by root cause and appealed with the operative report, implant invoice, or authorization documentation the payer is asking for, then fed back upstream so the same denial stops recurring.
Accounts receivable follow-up and recovery
Structured aging-bucket follow-up with priority on high-dollar surgical and implant claims and anything approaching timely filing.
Out-of-network and patient balance support
Good faith estimate support, out-of-network claim handling, patient statements, and clear balance explanations so patients understand what they owe and why.
Facility credentialing and payer enrollment
ASC facility enrollment, Medicare enrollment, re-credentialing, and payer contract maintenance so the center stays active with every network it depends on.
Reporting and analytics
Monthly reporting on collections, case volume versus claims submitted, net revenue per case, denial rate by reason, days in A/R, and payer-level performance.
Which Surgical Specialties
Do You Bill in the ASC Setting?
Gastroenterology diagnostic and screening colonoscopy, polypectomy, EGD, and biopsy procedures, including the screening-versus-diagnostic distinction that drives so many patient balance disputes.
Orthopedics and sports medicine knee, shoulder, and hip arthroscopy, ACL reconstruction, rotator cuff repair, and joint procedures migrating into the ASC setting.
Ophthalmology cataract extraction with IOL, complex cataract cases, glaucoma procedures, and retinal work, with the IOL and device rules that go with them.
Pain management epidural and transforaminal injections, facet blocks, radiofrequency ablation, and spinal cord stimulator trials and implants.
ENT tonsillectomy, adenoidectomy, sinus surgery, and tympanostomy tube placement.
Podiatry and foot surgery bunionectomy, hammertoe correction, and other forefoot and hindfoot procedures.
Urology cystoscopy, stone procedures, and related outpatient surgical care.
Spine decompression and select fusion procedures now performed in the ASC setting, where authorization and implant billing carry the most weight.
Plastic and reconstructive surgery with the cosmetic versus reconstructive distinction and patient-pay workflow handled separately from insurance claims.
Which ASC CPT and ICD-10 Codes
Do You Work With?
| Code | What It Covers |
|---|---|
| 45378, 45380, 45385 | Diagnostic colonoscopy, colonoscopy with biopsy, colonoscopy with snare polypectomy |
| 43235, 43239 | Diagnostic EGD and EGD with biopsy |
| G0105, G0121 | Screening colonoscopy for high-risk and average-risk Medicare patients |
| 66982, 66984 | Complex cataract extraction with IOL and standard cataract extraction with IOL |
| 29826, 29827, 29881, 29888 | Shoulder decompression, rotator cuff repair, knee meniscectomy, ACL reconstruction |
| 64721, 64718 | Median nerve decompression at the wrist and ulnar nerve decompression |
| 28296, 28285 | Bunionectomy with first metatarsal osteotomy and hammertoe correction |
| 31231, 31237, 31255 | Diagnostic nasal endoscopy and functional endoscopic sinus procedures |
| 42820, 42826, 69436 | Tonsillectomy with adenoidectomy, tonsillectomy alone, tympanostomy tube placement |
| 52000, 52332 | Cystoscopy and cystoscopy with ureteral stent placement |
| 62321, 64483, 64493, 64635 | Epidural, transforaminal, facet, and radiofrequency ablation pain procedures |
| 63650, 63685 | Spinal cord stimulator lead placement and pulse generator insertion |
| C-codes and L-codes | Device, implant, and orthotic reporting in the facility setting |
| Z12.11 | Encounter for screening for malignant neoplasm of colon |
| H25.–, H40.– | Age-related cataract and glaucoma |
| M17.–, M23.–, M75.– | Knee osteoarthritis, meniscal derangement, rotator cuff and shoulder lesions |
| K21.–, K64.– | Gastro-esophageal reflux disease and hemorrhoids |
| J35.0–, H65.– | Chronic tonsillitis and adenoiditis, otitis media |
| G56.0– | Carpal tunnel syndrome by laterality |
The ASC Covered Procedures List and its rates are updated on a recurring basis by CMS. Tracking those updates and repricing against them is part of the service, not an add-on.
Which Modifiers Matter Most
in ASC Billing?
Procedure discontinued before anesthesia was administered. Facility setting only.
Procedure discontinued after anesthesia was administered. Facility setting only.
Distinct procedural service by separate encounter, structure, practitioner, or unusual non-overlapping service.
Bilateral and laterality reporting, formatted the way each payer accepts.
Multiple procedures, and the ASC payment reduction sequence that follows.
Reduced services, which is not interchangeable with 73 or 74 in the facility setting.
Screening colonoscopy converted to a diagnostic or therapeutic procedure, which changes patient cost-sharing.
ASC facility service indicator, still required by some commercial and state payers.
Advance beneficiary notice and non-covered service reporting.
Confusing 52 with 73 or 74 on a discontinued case is one of the most expensive routine errors in ASC billing, and one of the easiest to fix.
How Does Compliance Work in ASC Billing?
Facility documentation alignment
The facility claim has to tie to the operative report, anesthesia record, implant log, and recovery documentation. We code from those records so the claim is defensible if it's ever reviewed.
ASC payment system accuracy
Coverage, payment indicator, packaging status, and device-intensive treatment are verified per procedure before the claim is built not assumed from last year's rates.
Physician Self-Referral Law (Stark)
Physician-owned ASCs operate under specific referral rules. Billing workflows must not create or reinforce arrangements that fall outside applicable exceptions.
Anti-Kickback Statute
Federal law prohibits paying or receiving anything of value to induce referrals. ASC ownership and vendor arrangements are a known enforcement area.
False Claims Act
Claims submitted without supporting documentation carry substantial civil exposure. Every code we submit is tied to a document that supports it.
No Surprises Act
Good faith estimates, out-of-network notice and consent requirements, and independent dispute resolution deadlines are tracked as part of the billing workflow rather than handled ad hoc.
HIPAA and data security
All work is performed under signed HIPAA agreements with role-based PHI access, secure transfer methods, and no PHI on personal devices or unsecured channels.
In-House ASC Billing vs Outsourced: What to Compare
Before deciding, compare the full cost of both sides not just salary against a percentage rate.
What in-house billing actually costs:
- •Biller and coder salaries
- •Benefits and payroll taxes
- •Billing software and clearinghouse fees
- •Coding reference subscriptions
- •Continuing education and certification maintenance
- •Workstation and workspace overhead
- •The cost of coverage when your biller is sick, on leave, or resigns
What outsourced billing costs:
- •A percentage of collections
- •No salary
- •No benefits
- •No software licensing
- •No training budget
- •No single-point-of-failure risk
The number most centers miss: the revenue difference. A one-person in-house billing operation rarely has time to appeal every denial, chase every aged claim, verify every implant carve-out, and reconcile the surgical schedule against submitted claims. That gap is usually larger than the entire cost difference between the two models.
The free audit gives you your own numbers to run this comparison with, instead of an industry average that may not resemble your center at all.
How Does
Onboarding Work?
Free billing audit
We review a sample of recent facility claims, denials, implant billing, and your aged A/R to identify where revenue is being lost and how much is still recoverable.
Findings and scope
You receive a written summary and a clear proposal covering services, pricing, and timeline. No obligation to continue.
System access and setup
We work inside your existing ASC management and billing system. No migration, no software purchase, no disruption to your schedule.
Workflow mapping
We document your case mix, specialty split, top payers, implant and device lines, out-of-network exposure, contract terms, and current denial patterns.
Go live
New facility claims flow through our process while we work your existing aged A/R in parallel, starting with high-dollar surgical and implant balances.
Ongoing reporting and review
Monthly financial reporting, a dedicated ASC account manager, and a scheduled review call covering case volume, net revenue per case, and denial trends.
Typical onboarding runs two to four weeks depending on system access and center size.
Which Systems Do
You Work In?
We work directly inside your current platform rather than asking you to change systems. Our team has worked across eClinicalWorks, AdvancedMD, NextGen, athenahealth, Kareo/Tebra, DrChrono, CareCloud, Epic, and Cerner, along with ASC-specific management platforms.
If your system isn't listed, tell us which one you use in most cases we can be trained and productive in it within days.
Who Do We Work With?
We serve surgery centers nationwide, with a growing footprint in Indiana and New Jersey.
What Do ASC Billing Services Cost?
Our ASC billing services are priced as a percentage of monthly collections our revenue only grows when yours does. Your exact rate depends on case volume, specialty mix, payer mix, out-of-network exposure, and which parts of the cycle you want us to handle.
There are no setup fees and no long-term lock-in contracts. The free audit is the fastest way to get a number that's accurate for your center rather than a generic figure.
Why Choose EverCure Billing for ASC Billing?
We bill the facility side properly.
ASC claims are not professional claims with a different header. Payment indicators, packaging, device-intensive rules, and modifiers 73 and 74 are facility concepts, and we treat them that way.
Every case on the schedule gets reconciled.
Cases performed but never billed are the single most expensive gap in ASC revenue, and the easiest one to close.
Implants and carve-outs get claimed.
Invoices attached, thresholds checked, contract terms applied so the center isn't absorbing device cost on cases it already performed.
Out-of-network balances get worked.
Good faith estimates, notice and consent, and dispute resolution timelines are tracked, not left to expire.
Denial data goes back into coding.
Every denial reason is tracked so the same error stops repeating instead of being resubmitted indefinitely.
A dedicated ASC account manager.
One person who knows your case mix, your contracts, and your payers reachable directly, with a scheduled monthly review.
No long-term contracts.
We keep your business by performing, not by locking you in.
Is Your Surgery Center Leaving Money on the Table?
Most ASCs don't know how many cases on last quarter's schedule never turned into a submitted claim, how many implant carve-outs went unclaimed, what their real denial rate by reason is, or how much they're being underpaid against contracted facility rates until someone actually looks.
That's what the free audit is for. We review your recent claims, denials, implant billing, and aged A/R, then give you a written breakdown of what's recoverable and what's causing the leak. No cost, no obligation.
Frequently Asked Questions
About ASC Billing
For Medicare, ASCs bill on the CMS-1500 with place of service 24 not the UB-04 used by hospital outpatient departments. Some commercial and state Medicaid payers require a UB-04 facility claim instead. We submit on the form each payer actually accepts, which is one of the more common sources of avoidable rejections when a single default form is used for everyone.
The surgeon bills a professional fee for performing the procedure. The ASC bills a facility fee covering the room, staff, supplies, implants, and recovery care. Anesthesia is billed separately again by the anesthesia group. Same case, three claims, three sets of rules and the facility side is the one most billing companies handle poorly.
It's CMS's list of procedures payable in the ASC setting, along with the payment indicators that determine how each one is reimbursed and what's packaged into it. It's updated on a recurring basis. Working from an outdated version means either turning away payable cases or submitting claims that won't be paid at the rate you expected.
Yes. We identify device-intensive procedures, apply implant carve-out terms where your contracts allow, attach supporting invoices, and confirm the device portion is reimbursed rather than absorbed by the center.
They report a procedure discontinued in the facility setting 73 before anesthesia was administered, 74 after. Using modifier 52 or omitting a modifier entirely on a discontinued case means the center staffed, supplied, and prepared for a procedure and collects nothing for it.
Yes. We submit and track facility authorizations and coordinate with the surgeon's office so the authorization on file matches the procedure and CPT actually performed. Mismatched authorizations are a frequent cause of facility denials on cases the surgeon was paid for.
Yes. We support good faith estimate workflows, out-of-network notice and consent documentation, and independent dispute resolution timelines, which carry hard deadlines that turn collectible balances into write-offs when missed.
Both. Aged A/R is usually where the fastest recovery is available, so we work it in parallel with new claim submission, prioritizing high-dollar surgical and implant balances and anything nearing timely filing.
Yes. We log into your current system and work in it. There's no software to buy and no data migration required.
Yes. ASC facility enrollment, Medicare enrollment, re-credentialing, and payer contract maintenance are available bundled with billing or standalone.
All work is performed under signed HIPAA agreements with role-based PHI access, secure transfer methods, and no PHI stored on personal devices.
Start with the free billing audit. You'll get a written picture of where your facility revenue is leaking before you commit to anything.
Ready to Fix Your ASC Revenue Cycle?
Every unbilled case, unclaimed implant, and expired out-of-network deadline is money your center already earned. Let's go get it.
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• Pricing percentage decide whether to publish a % range or keep it quote-only. Currently quote-only.
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