471 Neb. Admin. Code, ch. 26, § 006
When billing Medicaid, the ASC must submit on the appropriate form or electronic format (see Claim Submission Table at 471-000-49).
All claims for ASC services must include the date of surgery and the physician's name and license number.
To claim the ASC facility fee, the ASC must use the appropriate HCPCS/CPT procedure codes as outlined in claim completion instructions (see 471-000-52) and see 471-000-409, state defined ASC Services code(s).
The ASC must use HCPCS/CPT procedure codes when billing for practitioner services and laboratory services. Regulations listed in 471 NAC 4-000 must be used for ambulance services. Regulations listed in 471 NAC 7-000 must be used for durable medical equipment and medical supplies.
471 Neb. Admin. Code, ch. 26, § 006