Ambulatory Surgical Center Billing Services
ASC billing involves facility fee coding, implant reimbursement, multiple procedure discounting rules, and payer-specific ASC fee schedules that differ from hospital outpatient rates.
Common Ambulatory Surgical Center CPT Codes
Our coders handle these ambulatory surgical center codes daily. This is not an exhaustive list.
2026 Medicare Allowables for Ambulatory Surgical Center CPT Codes by State
Medicare reimbursement for ambulatory surgical centerprocedures is not a single national number. Each code's allowable is adjusted by your state's Geographic Practice Cost Index (GPCI) and processed under that state's Medicare Administrative Contractor (MAC), so the same ambulatory surgical center CPT code pays a different amount in California than it does in Texas or Florida. The table below shows the 9 core ambulatory surgical centercodes our coders bill priced at each state's 2026 locality. The non-facility figure is what an office-based practice collects. The facility figure applies when the service is performed in a hospital-based setting.
Commercial carriers in each state typically reimburse above these Medicare benchmarks and state Medicaid below them, but the Medicare allowable is the contracting anchor every payer negotiation starts from. Compare any individual code across all states with our Medicare fee calculator by state.
| Code | Ambulatory Surgical Center Procedure | CA | TX | FL | NY | PA | IL | OH | GA | NC | MI |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 29881 | Knee arthroscopy with meniscectomy | $546.52 | $509.92 | $560.77 | $571.13 | $516.08 | $551.00 | $495.19 | $514.19 | $482.74 | $520.12 |
| 43239 | Upper GI endoscopy with biopsy | $478.36 | $413.49 | $428.49 | $464.16 | $413.37 | $416.13 | $390.04 | $405.47 | $393.35 | $402.27 |
| 45378 | Diagnostic colonoscopy | $422.96 | $373.71 | $391.92 | $417.90 | $374.71 | $382.23 | $355.75 | $369.07 | $355.86 | $367.93 |
| 66984 | Cataract extraction with intraocular lens insertion | $500.51 | $459.46 | $480.36 | $504.15 | $461.80 | $472.95 | $444.90 | $457.08 | $442.35 | $457.44 |
| 64483 | Lumbar transforaminal epidural injection | $300.66 | $261.75 | $270.90 | $292.66 | $261.77 | $263.59 | $247.74 | $257.00 | $249.59 | $255.15 |
| 11042 | Debridement, subcutaneous tissue, 20 sq cm or less | $149.29 | $130.99 | $137.03 | $146.76 | $131.24 | $133.45 | $124.33 | $129.11 | $124.63 | $128.55 |
| 49083 | Abdominal paracentesis with imaging guidance | $322.24 | $280.81 | $291.59 | $314.37 | $280.96 | $283.70 | $265.85 | $275.96 | $267.50 | $274.16 |
| 11600 | Skin lesion excision, malignant, 0.5 cm or less | $222.44 | $196.05 | $205.51 | $219.43 | $196.53 | $200.31 | $186.43 | $193.50 | $186.60 | $192.82 |
| 52000 | Diagnostic cystoscopy | $243.70 | $213.10 | $222.63 | $238.95 | $213.42 | $216.66 | $201.96 | $209.83 | $202.68 | $208.78 |
Full Ambulatory Surgical Center fee detail by state
2026 Medicare allowables for ambulatory surgical center CPT codes in California, processed under Noridian Healthcare Solutions (Jurisdiction E). See California medical billing.
| Code | Description | Non-Facility | Facility |
|---|---|---|---|
| 29881 | Knee arthroscopy with meniscectomy | $546.52 | $546.52 |
| 43239 | Upper GI endoscopy with biopsy | $478.36 | $128.98 |
| 45378 | Diagnostic colonoscopy | $422.96 | $170.41 |
| 66984 | Cataract extraction with intraocular lens insertion | $500.51 | $500.51 |
| 64483 | Lumbar transforaminal epidural injection | $300.66 | $105.03 |
| 11042 | Debridement, subcutaneous tissue, 20 sq cm or less | $149.29 | $58.39 |
| 49083 | Abdominal paracentesis with imaging guidance | $322.24 | $95.78 |
| 11600 | Skin lesion excision, malignant, 0.5 cm or less | $222.44 | $116.12 |
| 52000 | Diagnostic cystoscopy | $243.70 | $72.56 |
Source: 2026 Medicare Physician Fee Schedule, locality-adjusted by state MAC. Figures are for reference and contracting benchmarks, not a guarantee of payment.
Ambulatory Surgical Center Billing Challenges We Solve
Common billing problems in ambulatory surgical center and how our team handles them.
Facility vs Professional Split
Correct separation of facility and professional charges with appropriate forms.
Implant Reimbursement
Many payers have separate implant payment methodologies for ASCs.
Multiple Procedure Discount
Second and subsequent procedures are paid at reduced rates. Proper sequencing maximizes revenue.
Payer ASC Fee Schedules
ASC rates differ from HOPD rates and vary by payer.
Common Ambulatory Surgical Center Denial Reasons
We prevent these before submission and appeal aggressively when they occur.
Revenue Opportunities Most Ambulatory Surgical Center Practices Miss
Payer-Specific Ambulatory Surgical Center Billing Tips
Ambulatory Surgical Center Billing Best Practices
Practical tips from our coding team to maximize reimbursement and minimize denials.
Get Expert Ambulatory Surgical Center Billing Support
Free billing assessment for your ambulatory surgical center practice. See where revenue is leaking.
What We Handle for Ambulatory Surgical Center Practices
Why Choose Go Medical Billing for Ambulatory Surgical Center
ASC billing requires understanding the split between facility and professional fees, implant reimbursement methodologies, and ASC-specific fee schedules.
We serve ambulatory surgical center practices in all 50 states, starting at 2.49% of collections. Our credentialing team handles payer enrollment, and our A/R specialists recover aging claims.
Ambulatory Surgical Center Billing by State
We handle ambulatory surgical center billing in all 50 states. The 2026 Medicare allowables for ambulatory surgical center CPT codes in every state are in the fee table above. Open any state below for its full payer environment, Medicaid rules, and Medicare MAC policies.
Frequently Asked Questions
Get Expert Ambulatory Surgical Center Billing Support
Stop losing revenue to ambulatory surgical center coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.