Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › INPATIENT HOSPITAL AND OUTPATIENT FACILITY PAYMENT SCHEDULE AND RULES › Section 20-2-III - AMBULATORY SURGERY CENTER/OUTPATIENT FACILITY REIMBURSEMENT

Current through June 25, 2024
A. 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.