Ambulatory Surgical Centers (ASC)

Provider Representative:  Karen Murphy  Tel. (571) 348-5933
Email:  karen.murphy3@gainwelltechnologies.com

Reimbursement

Ambulatory Surgical Centers are reimbursed using a level system. A new reimbursement Level has been added effective 7/1/2024 for only CPT code 41899 - UNLISTED PROCEDURE, DENTOALVEOLAR STRUCTURES.  The new level is Level 10 which is reimbursed at $1,254.00

ASC Level Fee ASC Percent Provider Reimbursement
Level 1 $340.00 75% $255.00
Level 2 $455.00 75% $341.25
Level 3 $520.00 75% $390.00
Level 4 $643.00 75% $482.25
Level 5 $731.00 75% $548.25
Level 6 $840.00 75% $630.00
Level 7 $1,015.00 75% $761.25
Level 8 $989.00 75% $741.75
Level 9 $1,366.00 75% $1,024.50
Level 10 $1672.00 75% $1254.00

Please find a list of the current CPT codes and the assigned level in this ASC pricing document.  Any CPT code not on this list is not covered when provided by an ASC and will not be reimbursed.  There is no plan to modify this pricing at this time.