Facility fee
The center’s operating room, nursing, recovery and eligible supplies, drugs and implants belong to the facility workflow. Documentation and contract terms determine which charges are separately payable and which are packaged.
ASC facility billing & RCM · California
ASC Billing Services in California for Ambulatory Surgery Centers
California Billing Services provides ASC billing services in California for ambulatory surgery centers that need a coordinated facility revenue cycle. From eligibility and pre-authorization through operative-note coding, implant capture, claim submission, payment posting and denial recovery, the workflow is built around your center’s case mix and payer contracts.
- Facility claims, separate from professional fees
- Implants, supplies and operative-note coding
- Medicare, Medi-Cal and commercial payer rules
- Denials, underpayments and aged A/R
Facility-focused revenue cycleCalifornia payer contextSan Diego, CA
The facility claim
What ASC billing covers: the facility claim
ASC billing is the billing of the facility fee an ambulatory surgery center earns for a surgical case: the operating room, nursing staff, supplies, drugs, implants and recovery. It is separate from the professional claims the surgeon, anesthesiologist and pathologist submit for their own services.
That split creates different claim and reimbursement requirements. Medicare pays ASCs for eligible procedures on its ASC Covered Procedures List, applies payment indicators and multiple-procedure discounting, and has specific device-intensive payment rules. Commercial contracts can require a different claim form and revenue-code structure. The facility claim must be reviewed on its own terms, not copied from the surgeon’s professional billing.
Professional fees
The surgeon’s, anesthesiologist’s and pathologist’s professional services follow their own billing requirements. Coordinating the case record does not mean combining these separate claims or assuming the facility authorization covers every clinician.
Explore our California medical billing services for the wider claims workflow.
Built around your surgical cases
The Case Starts Before the Claim
Facility benefits, authorization and case documentation belong in one coordinated workflow, while the center’s facility fee stays separate from professional services.
Full cycle or focused support
Our ASC billing and coding services
We offer full-cycle outsourced ASC billing, or a single function where your in-house team needs help. ASC medical billing services connect case preparation, surgical coding and payment follow-up.
Eligibility, benefits and pre-authorization
Verify active coverage, facility benefits, referral requirements and case-specific authorization before surgery. Check that the authorization identifies the right facility, procedure and service date. A patient-responsibility estimate should distinguish expected coverage from a guarantee of payment.
Explore serviceASC coding
Review the operative note for CPT, HCPCS Level II and ICD-10-CM coding, modifiers and NCCI edits. Check the ASC Covered Procedures List and payment indicators where Medicare applies. Documentation queries should be resolved before an unsupported code reaches the claim.
Explore serviceImplant and supply capture
Match implant invoices and the surgical case record, reconcile eligible supplies and drugs, and review device-credit reporting under current payer rules. An implant’s presence on an invoice does not automatically make it separately reimbursable; packaging and contract terms still apply.
Charge entry and claim submission
Use the correct claim format for the payer. Medicare ASC facility claims generally use CMS-1500/837P with place of service 24. A commercial or Medi-Cal managed care contract may require UB-04/837I. Track clearinghouse acceptance separately from payer adjudication.
Explore servicePayment posting and underpayment recovery
Reconcile remittance lines with the expected contracted allowance, adjustments and patient responsibility. Identify missing lines, incorrect discounts and potential underpayments rather than treating a partial payment as a resolved case. Keep evidence available for a payer-specific dispute.
Denial management and appeals
Categorize denials by cause, determine whether a correction or appeal is appropriate, and track the applicable filing window. Operative notes, authorization records and contract language support the response. Feed recurring findings back into scheduling, coding and claim preparation.
Explore serviceA/R follow-up
Work open balances by payer, age, dollar value and deadline. Distinguish unreceived claims, pending adjudication, denials, underpayments and patient balances. Prioritize aged accounts without abandoning newer claims that are approaching an appeal or timely-filing limit.
Explore serviceOut-of-network billing
Review out-of-network benefits, medical necessity, single-case agreement requirements and applicable patient protections. Facility network status and professional network status can differ. Confirm the correct dispute path and any valid consent requirements before assigning responsibility to the patient.
Credentialing and payer enrollment
Coordinate facility and professional enrollment as separate workstreams. Medicare, Medi-Cal and commercial payers have their own applications, effective dates and location requirements. A surgeon’s participation does not, by itself, establish the center’s contracted or enrolled status.
Explore servicePatient billing
Reconcile the payer’s adjudication before preparing clear patient statements. Separate covered facility services from agreed patient-paid upgrades and explain adjustments accurately. Discuss payment-plan and patient-support requirements when defining the center’s billing scope.
Coordinate approvals with our prior authorization services and align the full workflow through revenue cycle management.
California payer requirements
How California law changes ASC billing in 2026
California’s payment and patient-protection rules change how a surgery center reviews claims, follows up and escalates disputes.
01
AB 3275: the complete-claim payment clock
California’s 2026 prompt-payment changes affect complete claims submitted to applicable state-regulated health plans and insurers. Review receipt dates, whether a claim is complete, the regulator and the plan’s response. Late-payment interest and escalation requirements depend on the governing rules; self-funded employer plans require a separate assessment. Preserve proof of receipt and the payment history when reviewing a late-paid claim.
02
AB 72 and out-of-network cases at in-network ASCs
AB 72 addresses non-emergency care from an out-of-network professional at an in-network facility, including an ASC. Facility and professional obligations must remain separate. Review patient protections, applicable federal surprise-billing rules and the appropriate California dispute process. Consent is not a blanket authorization to balance bill: the statutory conditions and case-specific requirements must be assessed.
03
Medi-Cal and Medi-Cal managed care
Medi-Cal fee-for-service and managed care are distinct billing paths. Plan assignment, facility enrollment, procedure coverage, authorization, claim format and timely filing all need review. L.A. Care, Health Net, Molina and Partnership HealthPlan are examples of plans with their own workflows. Verify current DHCS requirements, any late-filing exceptions and the member’s actual plan rather than applying one statewide checklist to every case.
Review the official DMHC AB 3275 guidance and AB 72 independent dispute process. Applicability and exceptions must be checked for the specific plan and case.
CY 2026 · Medicare ASC
Medicare ASC rules we code to (CY 2026)
Medicare ASC billing starts with procedure eligibility and the current payment files, then applies the case-specific coding and reimbursement rules.
California ASC Medicare claims are handled through Noridian, the Jurisdiction E Medicare Administrative Contractor. The CY 2026 changes to the covered-procedure list create new billing considerations, not automatic coverage or payment for every new case.
Covered procedures and payment indicators
The CY 2026 ASC Covered Procedures List and current quarterly updates determine procedure eligibility. Payment indicators describe whether a service is payable, packaged or subject to device-intensive treatment. A newly listed procedure still requires appropriate clinical selection, documentation and any applicable coverage review.
Multiple-procedure discounting
Some surgical procedures are subject to multiple-procedure reductions; others are exempt. Review the applicable indicator, allowed amount and sequencing before calculating expected reimbursement. Do not assume every additional procedure or every payer follows the same reduction.
Discontinued procedures
Modifiers 73 and 74 distinguish qualifying discontinued outpatient procedures by the stage reached, including whether anesthesia was administered. The operative record and current Medicare instructions must support the modifier; a cancellation before the relevant preparation stage is not automatically billable.
Drugs and discarded amounts
JW and JZ reporting applies to qualifying separately payable drugs from single-dose containers under Medicare rules. Document the administered and discarded amounts, units and container size. Packaged drugs and other exceptions should not be treated as though the same reporting rule applies universally.
Device-intensive cases and credits
Device-intensive payment and device-credit adjustments require case-level review against the current ASC payment files. Reconcile the implant record, invoice and credit information. Use the payer’s current reporting instructions rather than copying hospital outpatient device-credit conventions into every ASC claim.
ASC Quality Reporting
The ASCQR Program ties reporting compliance to the applicable annual payment update. Review the current measure specifications, submission windows and exceptions with the center’s quality team. Quality reporting and revenue-cycle reporting are related responsibilities, but one does not substitute for the other.
Source: CMS CY 2026 OPPS / ASC fact sheet. Confirm current CMS addenda, payer policy and documentation before billing; these examples are not coverage or payment guarantees.
Single-specialty and multi-specialty
Specialty ASC billing services
ASC specialty billing services need case-specific review because implants, screening benefits, patient upgrades and coverage limits vary by service line.
Orthopedic and spine ASC billing
Total joint replacements, arthroscopy and spine cases often involve implants and device-intensive payment. Reconcile implant charges, review procedure eligibility and keep the facility authorization aligned with the planned case. Changes to the surgical plan can require a fresh authorization and coding review.
Explore specialtyOphthalmology ASC billing
Cataract surgery, glaucoma procedures and retina cases require careful separation of covered services from patient-paid upgrades. Premium intraocular lenses and related services need appropriate disclosures and billing treatment. Determine when an Advance Beneficiary Notice applies rather than using one for every upgrade.
Explore specialtyGI and endoscopy ASC billing
Screening colonoscopies that lead to a biopsy or polyp removal can change coding and cost-sharing treatment. Review modifier PT and other payer-specific screening rules against the procedure report. Coordinate the facility, endoscopist and anesthesia records without assuming their claims have identical benefits.
Explore specialtyPain management ASC billing
Epidural injections, facet procedures, radiofrequency ablation and spinal cord stimulator cases face procedure-specific coverage and frequency requirements. Confirm the applicable LCD, diagnosis support and authorization before scheduling. Trial and permanent implant cases may need different documentation and billing review.
Multi-specialty ASC billing
ENT, urology, podiatry, gynecology, plastics and general surgery add different edits and documentation needs to a shared facility workflow. Segment case review and reporting by service line and surgeon so a recurring denial in one specialty is not hidden in the center-wide totals.
Case-level reconciliation
From the Operative Note to the Final Balance
The surgical record, implant invoice, authorization and remittance each tell part of the story. Reviewing them together helps identify unsupported charges, denials and payment variances.
Step by step
Our ASC billing process
A coordinated ASC billing process follows the surgical case from pre-case verification through payment review and A/R resolution.
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Pre-case verification
Review eligibility, facility benefits, authorization and the patient estimate before surgery. Resolve changes in procedure, location or coverage before the case proceeds.
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Coding
Code from the completed operative note and supporting record. Resolve missing information and confirm the current code set, coverage and modifiers before releasing charges.
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Charge capture and scrubbing
Reconcile implants, supplies and drugs with the case. Apply payer and NCCI edits, review packaged items and confirm that the facility claim remains separate from professional fees.
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Submission
Send the electronic claim in the payer-required format. Retain submission and receipt evidence, and resolve clearinghouse or payer rejections without confusing them with denials.
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Payment posting and variance review
Review remittance lines against the contract and applicable payment clock. Investigate adjustments, missing payments and potential late-payment interest.
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Denials, appeals and A/R
Work denials by root cause and deadline, then follow up on aged accounts by value and recoverability. Use the findings to improve the next surgical case’s billing workflow.
Discuss the steps your in-house team needs covered, from one billing function to the full facility revenue cycle.
Payer-by-payer review
California payers we work with
California ASC claims span Medicare, Medi-Cal and commercial arrangements. Your actual participation, contracts and authorization paths are confirmed when the engagement is scoped.
The document identifies the following payer and case categories for review. This is not a guarantee that every center, procedure or member is covered or that your center is contracted with a listed payer. Kaiser referral arrangements, delegated groups, workers’ compensation and personal-injury cases need their own routing and documentation checks.
- Medicare · Noridian Jurisdiction E
- Medi-Cal fee-for-service
- Medi-Cal managed care
- Anthem Blue Cross
- Blue Shield of California
- Kaiser contracted / referral cases
- Health Net
- Molina Healthcare
- L.A. Care
- UnitedHealthcare / Optum
- Aetna
- Cigna
- Humana
- TRICARE West
- Workers’ compensation
- Personal-injury cases
For separate case pathways, review workers’ compensation billing and personal-injury billing.
Your center’s systems
ASC software we work inside
ASC software access and claim interfaces are reviewed before starting, with the aim of working within the center’s established workflow where supported.
Discuss SIS (Surgical Information Systems) and your current practice-management setup with our team. The other platforms below were identified in your document for confirmation. Review permissions, reporting exports, clearinghouse connections and workflow responsibilities before making a no-migration assumption.
SIS · Surgical Information Systems
HST Pathways
Amkai
gMed
Provation
Waystar
Availity
Why outsource ASC billing services
Why California ASCs outsource billing to us
California surgery centers consider outsourcing when staffing gaps, administrative costs and unworked denials make a coordinated external billing workflow worth evaluating.
Facility-focused review
ASC facility rules, professional-fee separation and device-intensive cases guide the review rather than a general physician-billing checklist.
California payer context
Prompt-payment requirements, surprise-billing protections and Medi-Cal plan differences are considered alongside the center’s contracts.
Coordinated account communication
Define who manages questions about surgeons, case mix, contracts and open claims, and agree a reporting and escalation schedule before starting.
Clearly scoped pricing
Review case volume, specialty, payer mix and whether the engagement covers full-cycle billing or a selected function. Confirm fees, exclusions and contract terms in the proposal.
Privacy and access planning
Review BAA terms, role-based system access, audit-log requirements and the approved method for sharing records before providing any patient information.
A planned transition
Agree access, enrollment checks, open-claim ownership and legacy A/R responsibilities before go-live. The transition timeline depends on your center’s readiness and scope.
Reporting and visibility
ASC billing KPIs we report monthly
An ASC dashboard should make claim quality, collections and aged balances visible at the center, surgeon, specialty and payer level. Confirm the reporting cadence and calculations during scoping.
| Metric | What the report should show |
|---|---|
| Clean-claim rate | Claims accepted without initial rework, with a consistent definition and denominator. |
| Denial rate | Denied claims and dollars by payer, procedure and root cause. |
| Days in A/R | Outstanding receivables relative to average daily charges, using an agreed calculation. |
| Net collection rate | Collections against collectible revenue after appropriate contractual adjustments. |
| A/R over 90 days | Aged balances by payer, value and the next recoverable action. |
| Collections per case | Case-level collections segmented by surgeon, specialty and payer. |
| Underpayment recoveries | Variances identified, disputed and recovered, tracked separately by payer. |
Compare trends against your center’s own baseline and agreed goals. A target is not a measured result or a reimbursement guarantee. Separating new billing from legacy A/R also makes it easier to understand what changed and where follow-up is still needed.
Explore RCM reportingYour next step
Request an ASC revenue review
Start with a discussion of your center’s case mix, payer contracts, implant workflow and open A/R. A scoped revenue review can identify missed charges, unresolved denials and payment variances. Our team will confirm the review requirements and terms with you; share claims or remittances only through an agreed secure channel, not the contact form.
FAQ
ASC billing services in California: your questions answered
ASC billing services manage the facility-fee revenue cycle of an ambulatory surgery center: eligibility, authorization, coding, implant capture, claim submission, payment posting, denials and A/R follow-up. They are separate from the surgeon’s and anesthesiologist’s professional billing.
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