Precision ASC Billing Services Built for Ambulatory Surgery Centers
ASC billing sits at the intersection of facility coding, surgical procedure rules, implant reimbursement, and payer-specific authorization requirements. One error in any of these areas means lost revenue. Theiatrics manages every layer of it so your center runs at full financial efficiency.
What Theiatrics Bills for Your ASC
- → Facility fees for all surgical procedures performed at the ASC
- → Medicare APC payment group claims on UB-04 forms
- → Commercial and managed care plan facility claims
- → Implant and surgical device pass-through billing
- → Multiple procedure claims with correct reduction modifiers
- → Anesthesia coordination and crosswalk support
- → Supply and equipment add-on code billing
- → Prior authorization requests and concurrent reviews
- → Medicaid ASC facility fee claims by state
- → Workers' compensation and auto/liability facility claims
- → Secondary and tertiary payer claim coordination
- → Self-pay patient billing and payment plan management
Facility Fee vs. Professional Fee: ASC billing covers the facility fee for the use of the operating room, staff, equipment, and supplies. This is separate from the surgeon's professional fee, the anesthesiologist's fee, and any pathology or radiology charges. All must be billed correctly and independently, though they originate from the same procedure.
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What Makes ASC Billing Services Uniquely Complex?
Ambulatory surgery center billing is one of the most technically demanding types of healthcare billing. Unlike a physician's office that primarily deals with evaluation and management codes and common procedure codes, an ASC generates facility claims that must account for surgical procedure coding, implant and device billing, multiple procedure reduction rules, place of service designations, and a separate Medicare fee schedule that differs from both hospital outpatient and physician rates.
Every procedure performed at your ASC generates at least two separate claims: the facility fee (billed by the ASC) and the professional fee (billed by the surgeon, anesthesiologist, and any other providers). These claims are independent of each other but both depend on accurate procedure coding. If the facility fee uses a different CPT code than the surgeon's professional claim, payers flag the discrepancy and deny one or both claims.
On top of that, most commercial payers require prior authorization for procedures performed at ASCs, and managed care contracts often carry bundling rules, implant carve-outs, and case rate structures that differ significantly from Medicare's APC payment model. Managing all of this correctly across multiple payers and surgical specialties is a full-time specialty unto itself.
Theiatrics brings that specialty expertise directly to your billing department. Our team understands the coding logic, the payer rules, and the claim submission workflows that ASC billing demands, and we apply that knowledge to every case that moves through your facility.
ASC Billing Across Every Payer Type
Medicare APC Billing
Medicare reimburses ASC facility fees using Ambulatory Payment Classifications (APCs). Each procedure is assigned to an APC group with a fixed payment rate. When multiple procedures are performed in the same session, the multiple procedure reduction rule applies, paying 50% for the second and subsequent procedures. Our team applies APC groupings accurately and manages multiple procedure modifiers on every Medicare claim. We also handle Medicare's separate payment policy for qualifying implants and devices.
Commercial Insurance Billing
Commercial payers negotiate ASC rates through contracts that may use a percentage of Medicare APC rates, a percentage of billed charges, or case rates for bundled procedures. Each contract has its own authorization rules and timelines. We manage prior authorizations for every commercial payer your center works with, submit claims according to each contract's requirements, and identify underpayments when payers pay less than the contracted rate. Underpayment recovery from commercial payers is one of the highest-value services we provide for ASCs.
Medicaid ASC Billing
Medicaid covers ASC procedures in most states, though coverage and rates vary significantly by state. Some states reimburse ASCs at a percentage of Medicare rates, others use fee schedules, and managed care Medicaid plans have their own authorization processes. Our team understands the Medicaid ASC policies in every state where your facility operates and manages claims according to those state-specific rules, including managed care organization requirements for Medicaid beneficiaries.
Medicare Advantage & Managed Care
Medicare Advantage plans follow Medicare eligibility rules but each plan sets its own ASC coverage policies, prior authorization requirements, and reimbursement rates. These plans are often more aggressive about denying claims for missing authorizations than traditional Medicare. We track authorization requirements for every Medicare Advantage and commercial managed care plan in your payer mix and ensure no case goes to the billing queue without the proper approvals in place.
Our Complete ASC Billing Services
Prior Authorization Management
We handle prior authorization requests for all procedures across every payer in your case mix. Authorizations are obtained well before the scheduled date and tracked through expiration. We also manage concurrent reviews for extended cases and reauthorizations when scheduling changes occur.
Eligibility & Benefits Verification
We verify insurance eligibility, ASC-specific coverage, deductible and out-of-pocket balances, and in-network status for every patient before their procedure. This prevents coverage surprises that create billing headaches and patient disputes after the fact.
Facility Fee Coding & Charge Entry
Our certified coders review operative reports and assign the correct CPT, HCPCS, and ICD-10 codes for every ASC case. We apply the appropriate place of service code, revenue codes, and condition codes on every UB-04 claim to ensure accurate submission from the start.
Implant & Device Billing
Surgical implants and devices represent significant revenue that many ASCs fail to capture fully. We identify all separately billable implants, apply the correct HCPCS pass-through codes, and bill them according to each payer’s implant reimbursement policy to recover every dollar the facility is entitled to.
Multiple Procedure Management
Cases with multiple procedures in the same operative session require precise modifier application to comply with multiple procedure reduction rules. We apply modifiers 51, 59, XU, and others accurately so claims process correctly without triggering bundling-related denials or payer audits.
Denial Management & Appeals
When a claim is denied, we analyze the reason code, correct the root cause, and resubmit within 48 hours. For clinical necessity denials and authorization-related appeals, we prepare detailed appeal packages with operative notes, clinical justification, and payer contract references when applicable.
AR Follow-Up & Collections
Aging AR is a persistent problem at ASCs with high case volumes. We work every unpaid and underpaid account systematically, following up with payers, patients, and secondary insurers until the balance is resolved or correctly written off according to your contractual obligations.
Contract Rate Verification
Commercial payers frequently short-pay ASC claims without explanation. We compare every remittance against your contracted rates and flag underpayments for appeal. Recovering underpayments from commercial payers is one of the fastest ways to increase net revenue without increasing case volume.
Revenue Cycle Reporting
You will receive detailed reports on case-level claim status, payer mix trends, denial root causes, days in AR by payer, and collection rates by procedure type so you have the data to make informed operational and contracting decisions.
ASC Billing for All Surgical Specialties
Orthopedics
Arthroscopy, joint injections, carpal tunnel release, fracture fixation, and soft tissue procedures with implant billing for screws, anchors, and plates.
Gastroenterology
Colonoscopies, upper endoscopies, ERCP, and polypectomy procedures. High-volume GI cases with strict bundling rules and screening vs. diagnostic distinctions.
Ophthalmology
Cataract surgery with IOL implant billing, glaucoma procedures, retinal repairs, and laser eye treatments with high implant cost components.
ENT
Tonsillectomy, adenoidectomy, sinus procedures, tympanostomy tube placement, and septoplasty with proper bilateral and multiple procedure modifier handling.
Pain Management
Epidural steroid injections, nerve blocks, spinal cord stimulator trials, joint injections, and fluoroscopy-guided procedures with separate imaging billing.
Urology
Cystoscopy, TURP, lithotripsy, ureteroscopy, and vasectomy procedures with proper instrument and scope charge management.
Podiatry
Hammertoe correction, bunionectomy, plantar fascia release, and nail procedures requiring correct toe and foot procedure coding and bilateral modifiers.
General Surgery
Laparoscopic cholecystectomy, hernia repair, appendectomy, and soft tissue mass excisions requiring both facility and supply charge coordination.
Neurosurgery / Spine
Lumbar discectomy, spinal fusion, laminectomy, and nerve decompression procedures with high implant costs requiring precise device billing and authorization management.
ASC Billing Challenges We Solve Every Day
Missing or Expired Authorizations
Prior authorization is required by most payers for virtually every procedure performed at an ASC. A missing, expired, or incorrect authorization is one of the leading causes of ASC claim denials, and these denials are often non-recoverable after the window closes.
How we help: We manage the authorization workflow for every scheduled case and track expiration dates proactively, ensuring no case reaches the billing queue without proper payer approval.
Incorrect Procedure Code Selection
Coding the wrong CPT for a surgical procedure, or failing to account for what was actually performed versus what was planned, creates discrepancies between the facility claim and the surgeon’s professional claim that payers use to deny both.
How we help: We code from operative reports, not just scheduling sheets. Every case is coded from the actual documentation of what occurred in the operating room, not what was originally planned.
Multiple Procedure Reduction Errors
When two or more procedures are performed in the same session, Medicare and most commercial payers reduce payment for secondary procedures. Failing to apply the correct modifiers triggers automatic denials or results in the payer bundling procedures that should be paid separately.
How we help: Our coders apply modifiers 51, 59, XU, and others with precision on every multi-procedure case, ensuring each billable service is reported correctly without triggering bundling alerts.
Missed Implant Revenue
Implants used in orthopedic, spine, and ophthalmic procedures often qualify for separate reimbursement beyond the facility fee. Many ASCs fail to capture this revenue because they lack the HCPCS coding knowledge or payer policy awareness to bill implants correctly.
How we help: We identify every billable implant or device used in each case, apply the correct HCPCS pass-through or add-on codes, and bill according to each payer’s implant reimbursement policy.
Commercial Payer Underpayments
Commercial payers frequently pay ASC claims at rates below what the contract specifies, often without explanation. Many ASCs accept these payments without reviewing them, leaving tens of thousands of dollars per year in contractually owed revenue uncollected.
How we help: We compare every commercial remittance against your contracted rates and identify short payments. Underpayments are appealed with contract citations before the appeal window expires.
Bundling Rule Violations
Payers apply NCCI (National Correct Coding Initiative) edits and proprietary bundling rules that prohibit billing certain code combinations together. Violating these edits, even accidentally, results in denials and potential compliance flags on your billing record.
How we help: We check every claim against current NCCI edits and payer-specific bundling policies during pre-submission scrubbing, catching bundling issues before they become denial patterns.
Why Ambulatory Surgery Centers Choose Theiatrics
How Much Revenue Is Your ASC Leaving Behind?
Most ambulatory surgery centers have at least two or three systematic billing gaps that quietly drain revenue month after month. They are usually not dramatic errors. They are small, repeatable mistakes that accumulate into significant annual losses.
A single orthopedic ASC that fails to separately bill for implants on just half of its eligible cases could be leaving $50,000 or more per year uncollected. A multi-specialty center with even a 5% commercial underpayment rate on $3 million in annual collections is absorbing $150,000 in losses that a proper billing review would uncover.
When Theiatrics takes over an ASC's billing, we start with a comprehensive review of the last 12 months of claims data. This review typically identifies recoverable revenue from underpayments, uncaptured implant billing, and unworked denials before we even begin managing new claims.
Ready to Maximize Your ASC's Revenue?
Let Theiatrics handle the complexity of ambulatory surgery center billing so your team can focus on running efficient, high-quality surgical care. Start with a free billing review and see exactly where your revenue stands.
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