Ala. Admin. Code r. 560-X-38-.06

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

Section 560-X-38-.06 - Surgical Procedures Groups

The surgical procedures shall be classified into separate payment groups. All procedures within the same payment group are reimbursed at a single rate. These rates are subject to adjustment by the Alabama Medicaid Agency. The group payment amount is lowest for Group One procedures and highest for Group Nine. A provider shall receive the lesser of the submitted charge or the designated group charge less the copay amount.

Ala. Admin. Code r. 560-X-38-.06

Amended by Alabama Administrative Monthly Volume XXXIII, Issue No. 02, November 26, 2014, eff. 12/17/2014.

Author: Solomon Williams, Associate Director, Insitutional Services, Managed Care Division

Statutory Authority: State Plan, Attachment 3-A; 42 C.F.R. §§405.310, 416.65.