23 Miss. Code. R. 210-1.4 - Covered Services

A. The Ambulatory Surgical Center (ASC) must have procedures for obtaining routine and emergency laboratory and radiology services from Medicare-approved facilities. The ASC, when contracting for those lab, x-ray and hospital services which directly relate to the surgical procedure, must be billed by the provider performing these services.

B. ASC services must be Medicare-approved items and services furnished by an ASC in connection with a covered surgical procedure furnished to a Medicaid beneficiary.

C. ASC services do not include items and services for which payment may be made under other provisions including, but not limited to, physician services, lab, x-ray or diagnostic procedures, other than those directly related to performance of the surgical procedure.

D. The ASC payment rate includes all the costs incurred by the ASC in providing services in connection with performing a specific procedure including, but not limited to, surgical supplies, equipment, and nursing services.

E. The Division of Medicaid covers the cost of corneal tissue used in corneal transplant cases. The reimbursement will be one hundred percent (100¢) of the cost reflected on the invoice from the donor supplier excluding transportation fees. Transportation fees are not covered under the Medicaid program. This rule is applicable only to an ASC.

F. The Division of Medicaid covers medically necessary dental treatment in the ASC setting when all the following are met:

1. Quality, safe, and effective treatment cannot be provided in an office setting,

2. Inpatient hospitalization is not medically necessary [Refer to Miss. Admin. Code Part 204, Rule 1.11.B.], and

3. Certain dental procedures have been prior authorized by the Division of Medicaid or designee.

Notes

23 Miss. Code. R. 210-1.4

42 C.F.R. Part 416; Miss. Code Ann. §§ 43-13-117, 43-13-121.

Amended 10/1/2019