Ohio Admin. Code 5160-4-23

Current through all regulations passed and filed through December 9, 2024

Section 5160-4-23 - Covered surgical procedures and professional services at ambulatory surgery centers (ASCs)

(A) Payment may be made to an ambulatory surgery center (ASC) in the form of a facility fee only for covered ASC surgical procedures, which are procedures that meet the standards set forth in 42 CFR 416.166 (October 1, 2017). Such procedures are listed on the department's website https://medicaid.ohio.gov/resources-for-providers/billing/fee-schedule-and-rates/fee-schedule-and-rates.

(B) Payment may be made to a physician for performing a covered surgical procedure in an ASC even if the surgery is not itself a covered ASC surgical procedure.

(C) Payment may be made to a physician for performing the professional component of a covered laboratory, radiologic, diagnostic, or therapeutic service in an ASC only if the physician personally performed the service and was not an employee of the ASC at the time.

Ohio Admin. Code 5160-4-23

Effective: 1/1/2024
Five Year Review (FYR) Dates: 10/3/2023 and 01/01/2029
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 09/01/1989, 12/29/1995 (Emer.), 03/21/1996, 01/01/2001, 07/01/2009, 07/09/2015, 01/01/2019