471 Neb. Admin. Code, ch. 26, § 003
ASC facility services are items and services provided by an ASC in connection with a covered surgical procedure defined in 471 NAC 26-002. These items and services are those that would otherwise be covered by NMAP if provided on a inpatient or outpatient basis in a hospital in connection with that surgical procedure.
The fee for ASC facility services includes payment for:
The fee for ASC facility services does not include payment for medical and other health services, such as physicians' services and prosthetic devices for which payment may be made under other NMAP payment plans, except for intraocular lenses. See 471 NAC 26-004, ASC Services Not Included in the ASC Facility Services Fee.
The fee for ASC facility services includes payment for all services provided by nurses and technical personnel who are employees of the ASC in connection with covered procedures. In addition to nursing staff, this includes orderlies, technical personnel, and others involved in patient care.
The fee for ASC facility services includes payment for operating and recovery rooms, patient preoperation areas, waiting rooms, and other areas used by the patient or offered for use by the patient's relatives in connection with covered procedures.
The fee for ASC facility services includes payment for all supplies and equipment commonly provided by the ASC in connection with covered procedures. Coverage of drugs and biologicals is limited to those which cannot be self-administered.
The following supplies and dressings are included in the ASC facility services fee:
The fee for ASC facility services includes payment for items and services provided by ASC staff in connection with covered procedures. With respect to diagnostic tests, many ASC's perform simple tests just before surgery, primarily urinalysis and blood hemoglobin or hemotocrit, which are generally included in their facility charges. To the extent that these simple tests are included in the ASC's facility charges, they are considered facility services. Under NMAP, diagnostic tests are not covered in laboratories independent of a physician's office, rural health clinic, or hospital unless the laboratory meets Medicare's requirements for independent laboratories; therefore, diagnostic tests performed by the ASC other than those generally included in the facility's charge are not included in the fee for ASC facility services. The ASC's laboratory may be certified as a independent lab by Medicare; in this case, the ASC may bill NMAP separately for the tests performed.
The ASC may make arrangements with an independent laboratory or other laboratory, such as a hospital laboratory, to perform diagnostic tests required before surgery; however, the necessary laboratory tests will generally have been done outside the ASC before surgery is scheduled because the tests results may determine whether the client's surgery should be performed on an outpatient basis.
The fee for ASC facility services includes payment for the general administrative functions necessary to run the facility, such as scheduling, cleaning, utilities, and rent.
The fee for ASC facility services includes payment for blood and blood products. No separate or additional payment is made for blood and blood products.
The fee for ASC facility services include payment for the anesthetic and any materials, disposable or reusable, necessary for its administration.
471 Neb. Admin. Code, ch. 26, § 003