471 Neb. Admin. Code, ch. 26, § 005
For services provided on or after January 1, 2008, NMAP will utilize the 2006 Medicare ambulatory surgical center group rates to reimburse for an ambulatory surgical center service. Reimbursement will be the surgical group rate specific to the procedure as established in 471-000-409.
If one covered ambulatory surgical procedure is provided in a single operative session, NMAP pays 100 percent of the applicable group rate. For example, excision of a benign lesion is a "group 1" procedure; therefore, NMAP would pay 100% of the "group 1" rate.
If more than one covered surgical procedure is provided in a single operative session, NMAP pays 100 percent of the applicable group rate for the procedure with the highest rate. NMAP pays for other covered ambulatory surgical procedures performed in the same operative session at 50 percent of the applicable group rate for each procedure. For example, hammertoe repair is a "group 4" procedure and tenotomy is a "group 1" procedure. Payment for these procedures performed in a single operative session in an ASC would be 100% of the "group 4" rate and 50% of the "group 1" rate.
The fee for facility services does not include payment for physicians' services or other services not directly related to the performance of the surgical procedure. (See 471 NAC 26-004.) The ASC may bill for these services in addition to the fee for ASC facility services and will be paid according to the appropriate Medicaid payment plan.
Medicaid may cover payment for facility services provided in connection with certain state-defined services provided in an ASC. See 471 NAC 18-004.17E.
Effective on or after the effective date of this regulation for facility services rendered by an ambulatory surgical center, payment will be denied for the following OPPCs:
471 Neb. Admin. Code, ch. 26, § 005