Ala. Admin. Code r. 560-X-39-.02

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-39-.02 - Facility Services

(1) In order for the Alabama Medicaid Agency to reimburse the facility for ESWL treatment, the facility must have a signed ESWL Contract with the Agency.

(2) For ESWL treatment to both kidneys during the same treatment period, Medicaid will pay the facility one-and-a-half times the regular reimbursement rate for this procedure.

(3) Repeat ESWL treatments on the same recipient within a ninety-day period will be reimbursed at half the regular reimbursement rate for this procedure.

(4) The ESWL reimbursement rate is an all-inclusive rate for each encounter and all services rendered in conjunction with the treatment (with the exception of the physician's and the anesthesiologist's) are included in the rate, such as lab, x-ray, and observation.

Author: Charles A. Reasner

Ala. Admin. Code r. 560-X-39-.02

Rule effective October 13, 1987.

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §§401, etseq.