5160-4-23 Covered ambulatory surgery center (ASC) surgical procedures.

(A) Payment may be made to an ambulatory surgery center (ASC) in the form of a facility fee only for covered ASC surgical procedures, which are procedures that meet the standards set forth in 42 CFR 416.65(a) and 416.65(b) (October 1, 2014). Such procedures are identified in appendix DD to rule 5160-1-60 of the Administrative Code.

(B) Payment may be made to a physician for performing a covered surgical procedure in an ASC even if the surgery is not itself a covered ASC surgical procedure.

(C) Payment may be made to a physician for performing the professional component of a covered laboratory, radiologic, diagnostic, or therapeutic service in an ASC only if the physician personally performed the service and was not an employee of the ASC at the time.

Replaces: 5160-4-23

Effective: 7/9/2015
Five Year Review (FYR) Dates: 07/09/2020
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 09/01/1989, 12/29/1995 (Emer), 03/21/1996, 01/01/2001, 07/01/2009