Issued by: Centers for Medicare & Medicaid Services (CMS)

This page provides basic information about being certified as a Medicare and/or Medicaid Ambulatory Surgical Center (ASC) supplier and includes links to applicable laws, regulations, and compliance information. ASCs  and the conditions for coverage (CfC) went into effect in 1982.

• An ASC must be certified and approved to enter into a written agreement with CMS. Participation as an ASC is limited to any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following an admission. An unanticipated medical circumstance may arise that would require an ASC patient to stay in the ASC longer than 24 hours, but such situations should be rare.
• The regulatory definition of an ASC does not allow the ASC and another entity, such as an adjacent physician's office, to mix functions and operations in a common space during concurrent or overlapping hours of operations. CMS does permit two different Medicare-participating ASCs to use the same physical space, so long as they are temporally separated. That is, the two facilities must not be open at the same time.
• ASCs are not permitted to share space, even when temporally separated, with a hospital or Critical Access Hospital outpatient surgery department, or with a Medicare-participating Independent Diagnostic Testing Facility (IDTF). Certain radiology services that are reasonable and necessary and integral to covered surgical procedures may be provided by an ASC; however, it is not necessary for the ASC to also participate in Medicare as an IDTF for these services to be covered.

Surveys and Appendix L of the State Operations Manual

Survey protocols and Interpretive Guidelines are established to provide guidance to personnel conducting surveys. They serve to clarify and/or explain the intent of the regulations and all surveyors are required to use them in assessing compliance with Federal requirements. The purpose of the protocols and guidelines is to direct the surveyor’s attention to certain avenues for investigation in preparation for the survey, in conducting the survey, and in evaluation of the survey findings.

The ASC survey is conducted in accordance with the appropriate protocols and substantive requirements in the statute and regulations to determine whether a deficiency citation of non-compliance is appropriate. The protocols and CfC requirements are outlined within Appendix L of the State Operations Manual. Deficiency citations are based on a violation of the statute or regulations, which, in turn, is to be based on observations of the ASC’s performance or practices. 

The Interpretive Guidelines include three parts:

• The first part contains the survey tag number. 
• The second part contains the wording of the regulation. 
• The third part contains guidance to surveyors, including additional survey procedures and probes.

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.