Ala. Admin. Code r. 560-X-38-.03

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

Section 560-X-38-.03 - Payment

(1) Payment shall be made for a surgical procedure performed on a Medicaid recipient only if the procedure is on the approved list.

(2) Ambulatory surgical center services are items and services furnished by an outpatient ambulatory surgery center in connection with a covered surgical procedure.

(3) Rates of reimbursement for ambulatory surgical center services include, but are not limited to:

(a) Nursing, technician and related services;

(b) Use of an ambulatory surgery center;

(c) Lab and X-ray, drugs, biologicals, surgical dressings, splints, casts, appliances, and equipment directly related to the provision(s) of the surgical procedure(s);

(d) Diagnostic or therapeutic services or items directly related to the provision of a surgical procedure;

(e) Administrative, record keeping, and housekeeping items and services; and

(f) Materials for anesthesia.

(4) Ambulatory surgical center services do not include items and services for which payment may be made under other provisions. Ambulatory surgical center services do not include:

(a) Physician services;

(b) Lab and X-ray not directly related to the surgical procedure;

(c) Diagnostic procedures (other than those directly related to performance of the surgical procedure);

(d) Prosthetic devices (except intraocular lens implant);

(e) Ambulance services;

(f) Leg, arm, back, and neck braces;

(g) Artificial limbs; and

(h) Durable medical equipment for use in the patient's home.

Author: Vicki W. Huff.

Ala. Admin. Code r. 560-X-38-.03

Rule effective September 1, 1986. Amended effective March 12, 1988.

Statutory Authority: State Plan, Attachment 3.1-A; 42 C.F.R. §§ 416.61, 416.65, 416.120.