471 Neb. Admin. Code, ch. 26, § 004

Current through September 17, 2024

Section 471-26-004 - ASC Services Not Included in the ASC Facility Services Fee

NMAP makes a single payment (the fee for ASC facility services) to an ASC which covers "facility services" provided by the ASC in connection with a covered procedure. The ASC may provide a number of items and services covered by NMAP which are not included in the fee for ASC facility services. The ASC may be part of a medical complex that includes other entities, such as an independent laboratory, a supplier of durable medical equipment, ambulance services, or a physician's office, which NMAP covers separately. Items or services which are not included in the fee for ASC facility services are:

1. Physicians' services;

2. The sale or rental of durable medical equipment for use in the patient's home;

3. Prosthetic devices, that is, artificial legs, arms, and eyes;

4. Ambulance services;

5. Orthotic devices, that is, leg, arm, back, and neck braces; and

6. Services provided by an independent laboratory. The ASC may provide these services and bill NMAP for them in addition to the fee for ASC facility serivces. Refer to the appropriate chapter in Title 471 for coverage conditions and payment policies.

004.01 Physicians' Services

This category includes most covered services provided in ASC's which are not considered ASC facility services. Physicians' services include services of anesthesiologists administering or supervising the administration of anesthesia to ASC patients and the patient's recovery from the anesthesia. Physicians' services also include any routine pre- and post-operative services, such as office visits, consultations, diagnostic tests, removal of stitches, and changing of dressings. See 471 NAC 18-004.17, Surgery, and 471 NAC 18-006, Payment for Physicians' Services.

004.02 Durable Medical Equipment

The following items are not included in the fee for ASC facility services; when provided by the ASC facility in connection with a covered procedure, the ASC may bill for these services in addition to the ASC facility services fee:

1. Ace bandages, elastic stockings and support hose, Spence boots and other foot coverings, leotards, knee supports, surgical leggings, gauntlets, and pressure garments for the arms and hands, and which are generally used as secondary coverings;

2. Surgical dressings that are reapplied later by others, including the patient or a family member;

3. Recasting and resplinting, when provided on a date other than the date the surgical procedure was performed.

When these dressings and supplies are obtained by the patient on a physician's order from a supplier other than the ASC facility, they are covered under 471 NAC 7-000 ff.

004.03 Ambulance Services

Ambulance services are not included in the fee for ASC facility services. Ambulance services provided by the ASC are covered as ASC services only if provided in conjunction with a covered ASC procedure and only when any other form of transportation is contraindicated for the patient's condition. Licensure and other ambulance regulations are covered in 471 NAC 4-000.

004.04 Laboratory Services

Except for those laboratory services included in ASC facility services under 471 NAC 26-003.04, laboratory services are covered in 471 NAC 10-003.04 and 18-004.29.

471 Neb. Admin. Code, ch. 26, § 004