Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 347.00 - Rates for Freestanding Ambulatory Surgery Center Services › Section 347.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 101 CMR
			 347.00 governs the rates of payment to eligible
			 freestanding ambulatory surgery centers (FASCs) to be used by all governmental
			 units for services provided to publicly aided individuals. Rates for services
			 provided to individuals covered by M.G.L. c. 152 (the Workers' Compensation
			 Act), are not set forth in
			 101 CMR
			 347.00, but are at 114.3
			 CMR 40.00:
Rates for Services Under M.G.L. c.
			 152, Workers' Compensation Act
.
(2)
Applicable Dates of
			 Service
. Rates contained in
			 101 CMR
			 347.00 apply for dates of service provided on or after
			 February 2, 2024, unless otherwise indicated.
(3)
Coverage
.
			 101 CMR
			 347.00 and the rates of payment contained in
			 101 CMR
			 347.00 are full compensation for facility services
			 furnished in connection with surgical procedures that can be performed safely
			 on an ambulatory basis in an FASC, are within the scope of covered services,
			 and meet the purchasing governmental unit's conditions of payment for such
			 facility services. Payment from any other sources will be used to offset the
			 amount of the purchasing governmental unit's obligation for such services
			 rendered to publicly aided individuals.
			 101 CMR
			 347.00 does not cover professional services that are
			 billed by a physician, dentist, or podiatrist separately from the surgery
			 center and who receives no other compensation for the professional services
			 rendered. Covered freestanding ambulatory surgery center services do not
			 include services performed in a hospital-based facility or medical, dental, or
			 podiatric surgical procedures that are customarily performed in an office
			 setting.
(4)
Disclaimer
			 of Authorization of Services
.
			 101 CMR
			 347.00 is not authorization for or approval of the
			 procedures for which rates are determined pursuant to
			 101 CMR
			 347.00. Governmental units that purchase care are
			 responsible for the definition, authorization, coverage policies, and approval
			 of the care and services extended to publicly aided individuals.
(5)
Coding Updates and
			 Corrections
. EOHHS may publish service code updates and
			 corrections in the form of an administrative bulletin. Updates may reference
			 coding systems including, but not limited to, the American Medical
			 Association's
CPT 2023 Professional Edition
. The publication
			 of such updates and corrections will list
(a)
			 codes for which the code numbers change, with the corresponding cross
			 references between new codes and the codes being replaced. Rates for such new
			 codes are set at the rate of the code that is being replaced;
(b) deleted codes for which there are no
			 corresponding new codes;
(c) codes
			 for entirely new services that require pricing. EOHHS will list these codes and
			 apply individual consideration (I.C.) reimbursement for these codes until
			 appropriate rates can be developed, unless
			 101
			 CMR 347.01(5)(d)  is
			 applied; and
(d) for entirely new
			 codes that require new pricing and that have Medicare rates, EOHHS may list
			 these codes and price them according to the rate methodology used in setting
			 FASC facility component rates.