Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-38 - AMBULATORY SURGICAL CENTER SERVICES
Section 560-X-38-.03 - Payment

Universal Citation: AL Admin Code R 560-X-38-.03

Current through Register Vol. 43, No. 02, November 27, 2024

(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.

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

Disclaimer: These regulations may not be the most recent version. Alabama may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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