Surgery Center Billing for Florida ASCs

The facility fee runs on the professional claim form under Medicare's ASC Payment System, and it is only payable when the procedure sits on the current ASC covered-procedures list with the correct payment indicator. Packaged supplies and drugs are folded into the facility payment and cannot be billed separately, while device-intensive cases need the implant invoice to recover the device value. All codes and modifiers appear only in the table below.

The combination of SMMC managed Medicaid, heavy Medicare Advantage, and no-fault auto is specific to Florida, and it means a facility claim here passes through more authorization and payer-rule checkpoints than in most states. A cataract case for a retiree may run under a Medicare Advantage plan requiring auth; the next patient's retina procedure may sit under a different SMMC plan; a slip-and-fall or auto injury may arrive as a PIP claim entirely. A biller who treats them all identically will watch clean cases deny for reasons that had nothing to do with the surgery. We route each case down the correct payer path from intake, so the facility fee is billed the way that specific plan pays it. Florida's non-CON market adds a second wrinkle: because centers open and expand freely, payer facility contracts and out-of-network status shift often, and an ASC that goes out-of-network with a plan mid-year must handle balance-billing under the federal No Surprises Act with good-faith estimates and, where needed, the independent dispute resolution process. We track each center's contract and network status so out-of-network cases are billed correctly instead of written off, and we keep credentialing and payer enrollment current so a lapsed facility contract never silently blocks payment.

In a market growing this fast, staffing an in-house facility-billing team that keeps pace with SMMC plan rules, MA authorization, and PIP handling is costly and hard to retain. Centers outsource to us because a dedicated ASC billing company carries the payment-indicator discipline, device-invoice rigor, and Florida payer knowledge that a general billing services company seldom maintains for facility claims. As a facility-focused medical billing services company, 247MBS posts a 99% first-pass clean-claim rate, up to 40% fewer denials, 90% of worked denials recovered, and days in A/R under 25, with 98% client retention across 20+ years and coders who are credentialed professionals. You keep a dedicated account manager and the free 360° dashboard, and when you outsource the facility claim you keep clinical and operational control. Start with the full ASC billing overview, our prior-authorization service, and the wider Florida medical billing services view.