Medicaid ASC coverage - service included and covered benefits

ASC services are items and services furnished by an outpatient ambulatory surgical center in connection with a covered surgical procedure. Rates of reimbursement for ASC services include, but are not limited to:

• Nursing, technician and related services
• Use of an ambulatory surgical center
• Lab and x-ray, drugs, biologicals, surgical dressings, splints, casts,
appliances, and equipment directly related to the provision of the surgical
procedure
• Diagnostic or therapeutic services or items directly related to the provision
of a surgical procedure
• Administrative, record keeping, and housekeeping items and services
• Materials for anesthesia



NOTE:
Outpatient dental care (procedure code D9420) must be prior approved and is covered only for recipients under the age of 21. The dentist is responsible for obtaining prior approval from the Alabama Medicaid Agency Dental Program at (334) 242-5472. Dental services provided to
SOBRA adult females are non-covered.

Ambulatory surgical center services are limited to three encounters each calendar year.