THE BOTTOM LINE
An ASC is not a physician office and not a hospital, and almost every ASC billing rule follows from that. Treat an ASC claim like either one and the denials will tell you so.
Four things drive most of the preventable loss: procedures billed without confirming they are on the covered procedures list, implants billed as separately payable when they are packaged, the multiple procedure reduction not applied before submission, and place of service coded as a hospital outpatient department.
CY 2026 is also an unusually large year for the covered procedures list. If you have not re-checked your procedure mix against it since January, that is the highest-value thing on this page.
What the full playbook covers
Solo subscribers read the full playbook. Here is what it contains.
- Definitions and frequently used terms
- Which claim form, and the facility versus professional split
- What changed for CY 2026
- Device and implant payment
- The multiple procedure reduction
- Prior authorization: the ASC demonstration
- Modifier SG
- The denial patterns you will actually see
- Practices that hold up
- Frequently asked questions
- How we work on this at ROI
- Two things to check in your own center this week
- Sources