CPT Codes Excluded From ASC Payment (Addendum EE)
This hub covers the 1,559 CPT and HCPCS codes that appear on CMS Addendum EE, the list of procedures Medicare does not pay for when they are performed in an Ambulatory Surgery Center. Excluded status does not mean a procedure is unsafe or never done outside a hospital. It means Medicare expects a different site of service, usually a hospital inpatient or outpatient department, or in some cases a physician office, and will not issue an ASC facility payment for the service.
The codes here span several patterns. Some are anesthesia services billed by the anesthesia provider rather than as an ASC facility line, such as 00176 (anesthesia for pharyngeal surgery), 00192 (anesthesia for facial bone surgery), and 00211 (anesthesia for cranial surgery for hematoma). Others are procedures CMS considers too clinically intensive or too closely tied to inpatient recovery to reimburse in the ASC setting, including newer Category III codes like 0075T. The common thread is the payment rule, not the specialty.
For an ASC, the practical question is what happens when one of these codes is scheduled or coded. Knowing a code sits on Addendum EE before the case lets the business office set expectations, route the procedure to the correct setting, or confirm whether a payer other than Medicare follows the same exclusion. DataLily's procedure library tracks CPT-specific prior-authorization and documentation requirements, which helps teams flag site-of-service and coverage questions earlier in the workflow.
Excluded from ASC Payment codes(showing 120 of 1,559)
What does it mean when a CPT code is excluded from ASC payment?
It means the code appears on CMS Addendum EE, so Medicare will not issue an ASC facility payment when the procedure is performed in an Ambulatory Surgery Center. Medicare expects the service to be done in another setting, typically a hospital inpatient or outpatient department, or sometimes a physician office. The exclusion is about where Medicare pays for the service, not about whether the procedure is clinically valid.
Can an ASC still perform a procedure that is on Addendum EE?
Clinical capability and Medicare payment are separate questions. A facility may be physically able to perform a service, but if the code is on Addendum EE, Medicare will not reimburse it at the ASC facility rate. Before scheduling, billers should confirm the site-of-service rules for the specific payer, since a non-Medicare payer may have a different policy, and route the case to the setting where it can be appropriately and compliantly billed.
Why are anesthesia codes like 00176 and 00211 on the excluded list?
Anesthesia CPT codes such as 00176 (pharyngeal surgery) and 00211 (cranial surgery for hematoma) are billed by the anesthesia provider as professional services, not as an ASC facility line item. They appear on Addendum EE because there is no separate ASC facility payment for them. The ASC is reimbursed for the covered surgical procedure on Addendum AA, while the anesthesia professional service is billed and paid separately.