Section 20-2-III - AMBULATORY SURGERY CENTER/OUTPATIENT FACILITY REIMBURSEMENTA. Reimbursement for all hospital-based outpatient and freestanding ambulatory surgery center services shall be based on the Ambulatory Payment Classification (APC) system as developed by the Centers for Medicare and Medicaid Services (CMS) using the relative weights effective January, 2019.B. For implantables used in the outpatient setting, reimbursement is included in the Fee Schedule APC Amount as listed.C. Coding and Billing Rules 1. Facility fees for ambulatory surgery must be billed on the UB-04 form.2. The CPT/HCPCS code(s) of the procedure(s) performed determines the reimbursement for the facility fee. Report all procedures performed.3. If a procedure code is assigned a status indicator of J1, then other charges/procedure codes on the bill are considered packaged in the J1 payment and no additional reimbursement is due. If there are multiple codes with status indicator J1 on the bill, only the J1 code with the highest value will be reimbursed. For purposes of this fee schedule, certain procedure codes have been assigned a Mississippi state-specific status indicator of J1*. Outpatient Facility and Ambulatory Surgery Center reimbursement for these procedure codes will follow the guidelines set forth for reimbursement of codes with a status indicator of J1.
4. Do not separately reimburse non-implantable orthotic and prosthetic devices when associated with a procedure code that has a status code of J1. Payment is packaged into the allowable for the procedure code.5. If more than one surgical procedure is furnished in a single operative encounter and none of the codes have a status indicator of J1, the multiple procedure rule applies. The primary procedure is reimbursed at the lesser of the billed charges or one hundred percent (100%) of the MAR. The second and subsequent procedures are reimbursed at the lesser of the billed charges or fifty percent (50%) of the MAR listed in the Fee Schedule. The primary procedure is the procedure with the highest relative weight.6. Other than the multiple procedure surgical discounts as listed in Section III C. 3. and the J1 status indicators described in the previous paragraph, no other Medicare status indicator discounts apply. This means no discounts apply to Medicare's Q status indicator codes.7. If the total billed charge for an outpatient surgical encounter is less than the APC MAR, the billed charge is paid to the facility.8. The payment rate for an APC surgical procedure includes all facility services directly related to the procedure performed on the day of surgery. Facility services include: * Nursing and technician services;
* Use of the facility;
* Drugs, biologicals, surgical dressings, splints, casts and equipment directly related to the provision of the surgical procedure;
* Implantables;
* Materials for anesthesia; and
* Administration, record keeping and housekeeping items and services.
9. Separate payment is not made for the following services that are directly related to the surgery: * Pharmacy;
* Medical/surgical supplies;
* Sterile supplies;
* Laboratory and radiology services with no APC Amount;
* Operating room services;
* Anesthesia;
* Ambulatory surgical care;
* Recovery room; and
* Treatment or observation room.
10. Pre-op workup services are included in the APC Amount and do not warrant separate reimbursement regardless of the date of service. Pre-op workup includes: Metabolic Panel, CBC, UA, PT, PTT, EKG, CXR (or any of the components). Note: If a surgical procedure is cancelled after the pre-op has been completed, then the pre-op services should be paid according to this Fee Schedule.11. The ASC payment rate (APC Amount) is included in the CPT code listing of fees in the Fee Schedule. The column lists the total approved facility fee for that particular CPT code.12. The facility fees will be paid for medically necessary services only. All ambulatory elective procedures must be precertified according to the rules and guidelines of the Fee Schedule. 13. Procedures not assigned an APC Amount will be reimbursed according to the lesser of total billed charges or the usual and customary rate.14. Charges for outpatient surgical codes are all inclusive and are reimbursed in total regardless of the amount billed on that line as long as the total reimbursement does not exceed the total billed charges.20 Miss. Code. R. § 2-III