Unlocking Opportunities: The Growth of Hybrid ASC/OBL Development

An irASC is a healthcare facility that offers a broader range of services than a typical ASC. It may provide both outpatient surgical procedures, similar to an ASC, and a variety of diagnostic tests and treatments that are commonly associated with an OBL, all within the same facility. This setup can be convenient for patients and healthcare providers as it allows for a wider spectrum of care in one location.

A Paradigm Shift in Reimbursement

Until 2016, Medicare had not added a sufficient number of procedures to its approved list for irASC reimbursement. However, with a focus on cost-cutting and patient access, Medicare steadily expanded the list of CPT codes supporting irASC facility fees:

In 2016, approximately 117 new IR procedure codes were added.

In 2017, close to 90 new codes joined the list, bringing the total to over 230 CPT codes supporting irASC facility fees.

In 2018, an additional 176 irASC CPT codes were included.

This trend is expected to continue, with the healthcare industry pushing for more procedures to be performed in ASC settings to reduce costs and increase efficiency.

A Budding Business Opportunity

Reimbursement for irASC cases often exceeds four figures per procedure, making it an attractive investment for interventional radiologists. For instance, a procedure that could result in a hospital charge of around $25,000 may be performed in an irASC for an all-inclusive fee of $10,000 to $15,000, proving quite profitable due to the lower cost structure of surgery centers.

Consider these examples of scheduled irASC fees:

CPT code 33213 generates Medicare irASC reimbursement of over $7,600, while the same procedure performed in a physician’s office yields only around $350.

CPT code 33210 generates Medicare irASC reimbursement of more than $3,600, versus a little over $170 in an office setting.