5160-22-02 Covered ambulatory surgery center (ASC) services.

(A) Covered ASC surgical procedures.

(1) "Covered ASC surgical procedures" are procedures designated in appendix DD to rule 5101:3-1-60 of the Administrative Code.

(2) Covered ASC procedures shall be listed under the column headings "Current ASC Group" and "Previous ASC Group" in appendix DD to rule 5101:3-1-60 of the Administrative Code, identified by number one, two, three, four, five, six, seven, eight or nine as described in paragraph (A)(2) of rule 5101:3-22-03 of the Administrative Code.

(3) The inclusion of any procedure as a covered ASC surgical procedure determines that reimbursement for facility services may be paid to an ASC and does not preclude its coverage in an inpatient or outpatient hospital setting.

(B) Noncovered ASC surgical procedures.

A facility fee is not reimbursable to an ASC for the following procedures:

(1) Surgical procedures not designated as covered ASC surgical procedures in appendix DD to rule 5101:3-1-60 of the Administrative Code; and

(2) Surgical procedures, regardless of their designation in appendix DD to rule 5101:3-1-60 of the Administrative Code, if they are not reimbursable under paragraphs (A)(1) to (A)(2)(g) of rule 5101:3-2-03 and rule 5101:3-4-28 of the Administrative Code.

(C) Covered ASC facility services.

"ASC facility services" are items and services furnished by an ASC in connection with a covered ASC surgical procedure. Facility services include but are not limited to:

(1) Nursing, technician, and related services;

(2) Use of the ASC facilities;

(3) Drugs, biologicals (e.g., blood), surgical dressings, splints, casts and appliances, and equipment directly related to the provision of the surgical procedure;

(4) Diagnostic or therapeutic services or items directly related to the provision of a surgical procedure;

(5) Administrative, recordkeeping, and housekeeping items and services;

(6) Materials for anesthesia;

(7) Intraocular lenses; and

(8) Supervision of the services of an anesthetist by the operating surgeon.

Effective: 07/01/2009
R.C. 119.032 review dates: 02/11/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021
Prior Effective Dates: 3/20/84, 1/4/88, 2/17/91, 12/29/95 (Emer), 5/21/96, 1/1/04