Section 7 AAC 145.220 - Physician surgical procedures payment rates(a) The department will pay an in-state physician for surgical procedures in accordance with the physician payment rates determined under 7 AAC 145.050, subject to the following exceptions: (1) the highest-valued procedure of multiple surgeries performed on the same recipient during the same operative session or on the same day will be paid at 100 percent of the rate determined under 7 AAC 145.050, and each additional surgery at 50 percent of the rate determined under 7 AAC 145.050;(2) bilateral surgeries will be paid at the lesser of billed charges or 150 percent of the rate determined under 7 AAC 145.050;(3) co-surgeons will be paid for the same surgical procedure, if medically necessary, by increasing the payment rate determined under 7 AAC 145.050 by 25 percent and splitting the payment equally between the surgeons;(4) intra-operative procedures only billed using modifier -54 from the list of modifiers set out in Current Procedural Terminology, adopted by reference in 7 AAC 160.900, will be paid at the lesser of billed charges or 80 percent of the rate determined under 7 AAC 145.050;(5) pre-operative services that are performed by a physician other than the surgeon, and that are billed using modifier -56 from the list of modifiers set out in Current Procedural Terminology, adopted by reference in 7 AAC 160.900, will be paid at the lesser of the billed charges or 10 percent of the rate determined under 7 AAC 145.050;(6) postoperative services that are performed by a physician other than the surgeon, and that are billed using modifier -55 from the list of modifiers set out in Current Procedural Terminology, adopted by reference in 7 AAC 160.900, will be paid at the lesser of billed charges or 10 percent of the rate determined under 7 AAC 145.050;(7) supplies associated with surgical procedures performed in a physician's office will be paid only when a surgical procedure is approved for payment for the same date of service in the physician's office; the department will pay the lesser of the billed charges or the rate determined under 7 AAC 145.050(h).(b) The department will pay a physician acting as a surgical assistant the lesser of billed charges or 25 percent of the rate determined under 7 AAC 145.050. The department will pay an advanced practice registered nurse acting as a surgical assistant the lesser of billed charges or 25 percent of the rates established for advanced practice registered nurse under 7 AAC 145.100.(c) The department will pay a physician for the use of a physician assistant, acting as a surgical assistant, the lesser of billed charges or at the same rate paid to an advanced practice registered nurse as described in (b) of this section.(d) The department will pay an out-of state physician for surgical procedures in accordance with 7 AAC 145.025 and this section.Eff. 2/1/2010, Register 193; am 4/24/2020, Register 234, April 2020Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040