Ambulatory Surgical Center Groupers
Starting April 1, 2024, the ASC Grouper 2024 reimbursement policy for EmblemHealth and ConnectiCare has been updated to include new codes. For provider contracts that follow a grouper payment methodology, ambulatory surgical center groupers will be paid according to surgical contracted rates when billed with revenue codes 360 or 490. If surgical services are billed with revenue codes other than 360 or 490 — and the claims contain charges for anesthesia and/or recovery room — claims will be paid according to the surgical contracted rates unless otherwise negotiated.
Updated Reimbursement Policies
The following reimbursement policies are being updated. If the policy name does not have a company name shown, the policy applies to both EmblemHealth and ConnectiCare. See their revision histories for effective dates and applicable changes:
- Bundled Services Reimbursement Policy (Commercial and Medicare)
- CPT and HCPCS Billing Guidelines (Commercial and Medicaid)
- Corrected Claim Submission
