Covered dental surgical procedures in the ASC are assigned to one of four groups for reimbursement purposes. Billing instructions are in Section 242.110.
A. Medicaid has established a maximum allowable fee for each dental surgical group.
1. Reimbursement is the lesser of the billed charge or the maximum allowable fee for the applicable dental surgical group.
2. The maximum allowable fees are global fees that include all of the covered ASC facility services listed in Section 210.200.
B. When multiple surgical procedures are performed on the same date of service, surgical procedures subject to the multiple procedure (MP) discount will be reimbursed in the following manner:
1. The surgical code with the highest reimbursement will be paid at 100%; the 2nd code at 50% if subject to the MP discount and the 3rd code at 50% if subject to the MP discount.
2. Procedures not subject to the MP discount and allowed separate reimbursement will be reimbursed according to the ASC fee schedule.
Credits
Eff. Nov. 1, 2008; May 1, 2007; Oct. 13, 2003. Amended July 1, 2014.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.3-230.100, AR ADC 016.06.3-230.100
