Ala. Admin. Code r. 560-X-38-.07

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

Section 560-X-38-.07 - Submission Of Claims

(1) Ambulatory surgical center services are treated as medical services. UB82 claim forms shall be submitted for payment listing facility provider number, HCFA Common Procedure Coding System (HCPCS) and ICD-9-CM diagnosis codes (dates services prior and up to September 30, 2015) or ICD-10-CM diagnosis codes (dates of services October 1, 2015 and forward).

(2) If one covered surgical procedure is furnished to a Medicaid recipient in an operative session, payment shall be at the lesser of the submitted charges, or 100 percent of the predetermined rate for the procedure.

(3) If more than one covered surgical procedure is furnished to a Medicaid recipient in a single operative session, payment shall be made at the lesser of the submitted charges, or at the full amount for the procedure with the higher predetermined rate less the copay amount. Other covered surgical procedures furnished in the same session will be reimbursed at the lesser of the submitted charges, or at 50 percent of the predetermined rate for each of the other procedures.

Ala. Admin. Code r. 560-X-38-.07

Rule effective September 1, 1986.

Amended by Alabama Administrative Monthly Volume XXXIII, Issue No. 12, September 30, 2015, eff. 10/1/2015.

Author: Solomon Williams, Associate Director, Institutional Services

Statutory Authority:42 C.F.R. § 416.120.