Idaho Admin. Code r. 16.03.09.455

Current through September 2, 2024

Section 16.03.09.455 - AMBULATORY SURGICAL CENTER SERVICES: PROVIDER REIMBURSEMENT

01.Payment Methodology. ASC services reimbursement is designed to pay for use of facilities and supplies necessary to safely care for the patient. Such services are reimbursed as follows:

a. ASC service payments represent reimbursement for the costs of goods and services recognized by the Medicare program under 42 CFR, Part 416 . Payment will be determined by the Department. Any surgical procedure covered by the Department, but which is not covered by Medicare will have a reimbursement rate established by the Department.

b. ASC services include the following:

i. Nursing, technician, and related services;

ii. Use of ASC facilities;

iii. Drugs, biologicals, surgical dressings, supplies, splints, casts, and appliances and equipment directly related to the provision of surgical procedures;

iv. Diagnostic or therapeutic services or items directly related to the provision of a surgical procedure;

v. Administration, recordkeeping, and housekeeping items and services; and

vi. Materials for anesthesia.

c. ASC services do not include the following services:

i. Physician services;

ii. Laboratory services, x-ray or diagnostic procedures (other than those directly related to the performance of the surgical procedure);

iii. Prosthetic and orthotic devices;

iv. Ambulance services;

v. DME typically used in the participant's place of residence, but may be suitable for use in any setting in which normal life activities take place, other than a hospital, nursing facility, or ICF/IID; and

vi. Any other service not specified in Subsection 455.01.b. of this rule.

02.Payment for Ambulatory Surgical Center Services. Payment is made at a rate established under Section 230 of these rules.

Idaho Admin. Code r. 16.03.09.455

Effective July 1, 2024