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18.2.4 Ambulatory Surgical Centers (Hospital-Based and Freestanding)
Reimbursement of ASC procedures, whether hospital-based (HASC) or free-standing, is based on the Centers for Medicare & Medicaid Services (CMS)-approved Ambulatory Surgical Code Groupings (Groups 1 through 9 per CMS and group 10 per the Texas Health and Human Services Commission [HHSC]) payment schedule. Providers are sent a list of these codes and payment categories upon enrollment with the Texas Medicaid Program, a prerequisite to enrollment in the CSHCN Services Program. Updates are supplied by the Texas Medicaid Program. Reimbursement of day surgeries for CSHCN Services Program clients is based on Medicaid rates for ASCs or HASCs. Routine X-ray and laboratory services directly related to the surgical procedure are not reimbursed separately. Payment for these services is included in the reimbursement of the surgical procedure. All nonroutine laboratory and X-ray services should be billed separately using the hospital's full care provider identifier.
All surgical procedures performed in an ASC or HASC must be billed using the appropriate national procedure code. Day surgery payment represents a global payment. It is not appropriate to bill separately for any supplies or other services related to the surgery. Physician services must be billed separately.
Day surgery services include prosthetic devices, such as an intraocular lens (IOL), when supplied by the day surgery facility and implanted, inserted, or otherwise applied during a surgical procedure that is a benefit.
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