148 ◾ Appendix: Synopsis of the Medicare Program’s Payment Systems
Ambulance
Ambulance services are paid through the Ambulance Fee Schedule (AFS). Provisions in the AFS
do allow for additional payment for rural ambulance services. If a CAH owns the ambulance ser-
vice and can meet the requirements found in the provider-based rule (PBR), then these ambulance
services can be paid on a cost basis.
See Fee Schedule Payment Systems, for further discussion.
Ambulatory Surgical Centers
For Medicare, ASCs are paid through a combination of APCs and the MPFS. Only approved sur-
gical procedures may be performed at an ASC. Generally, ASCs are paid approximately 65percent
of the APC payment unless the surgery can be performed in a physician’s oce; then, ...