Ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs) can perform similar procedures, but payer reimbursement often differs significantly. Understanding ASC vs HOPD payment rules helps surgeons, administrators, and billing teams capture appropriate revenue and avoid costly filing mistakes.
Site-of-service impact on reimbursement
Medicare and many commercial payers maintain separate fee schedules for ASCs and HOPDs. ASC rates are typically lower than HOPD rates for the same CPT code, reflecting lower facility overhead. However, ASC cases may still be more profitable for physicians when operational costs and case volume are favorable.
Key billing considerations
- Verify place-of-service codes and modifier requirements on every claim
- Confirm whether the procedure is on the ASC approved list for Medicare
- Track payer-specific contracts that override standard fee schedules
- Monitor denials tied to incorrect POS or missing prior authorization
How Docrevrcm helps
Our revenue cycle team reviews site-of-service rules during onboarding and ongoing audits so your claims align with payer policy. We help ASCs and hospital-based practices reduce denials and accelerate collections.