Ala. Admin. Code r. 560-X-24-.05

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-24-.05 - Ancillary Services

(1) Medically necessary take-home drugs must be billed under the pharmacy program by the actual provider of services.

(2) Routine parenteral items are included in the facility composite rate and may not be billed separately.

(3) Nonroutine injectables administered by the facility may be billed by the facility actually providing this service. Nonroutine injectables are defined as those given to ameliorate an acute condition such as arrhythmia or infection.

(4) Routine drugs or injectables administered in conjunction with dialysis procedures are included in the facility's composite rate and shall not be billed separately. These include but are not limited to the following:

Heparin Glucose

Protamine Dextrose

Mannitol Antiarrythmics

Saline Antihistamines

Pressor drugs Antihypertensives

(5) The administration fee for injectables is included in the facility's composite rate for dialysis and must not be billed separately under a physician provider number.

(6) Reimbursement for procedures cannot exceed the allowable amount under Medicaid. The following procedures are nonroutine and must be billed by the actual provider of service.

(a) 5-76061 - Bone Survey - annually (roent-genographic method or photon absorptrometric procedure for bone mineral analysis)

(b) 5-71020 - Chest X-ray - every six months

(c) 6-95900 - Nerve Conductor Velocity test (Peroneal NCV) - every three months

(d) 6-93000 - EKG - every three months

Author: Vicki W. Huff

Authority: State Plan, 4.19-E, Title XIX, Social Security Act; 42 C.F.R. §§ 416.61, 416.65, 416.120.

Ala. Admin. Code r. 560-X-24-.05

Rule effective October 1, 1982. Amended: Effective January 14, 1987; August 10, 1987; November 15, 1989.