23 Miss. Code. R. 210-1.6 - Reimbursement
A. Mississippi
Medicaid Ambulatory Surgical Care (ASC) rates are updated October 1 of each
year based on eighty percent (80%) of the Medicare ASC Payment System rate in
effect July 1 of that year set by the Center for Medicare and Medicaid Services
(CMS).
B. Reimbursement is in
accordance with the Medicaid ASC Procedure Schedule or the provider's usual and
customary charges, whichever is less.
C. The Division of Medicaid reimburses for
multiple procedures as outlined in Miss. Admin. Code Part 203, Chapter
4.
D. Surgical or other procedures
canceled due to scheduling conflicts of the operating suite or physician,
beneficiary request, or other reason not related to medical necessity, cannot
be billed and no payment will be made for the procedure. Services provided
prior to the procedure may be billed and are subject to coverage rules for
those services.
E. For surgical or
other procedures canceled or terminated before completion due to changes in the
beneficiary's medical condition that threaten his/her well-being, only the
services that were actually performed may be billed are subject to coverage
rules for those services. Clear documentation regarding the medical necessity
for cancellation or termination of the procedure must be provided.
F. ASC providers must bill the procedure code
that accurately reflects the dental services rendered as follows:
1. Dental procedures performed by a
Mississippi licensed dentist must be billed with a Code on Dental Procedures
and Nomenclature (CDT).
2. Dental
procedures performed by a Mississippi licensed dentist who is also a
Mississippi licensed physician can bill either a CDT code or a Current
Procedural Terminology (CPT) code.
Notes
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