Medicaid Fee Schedule 2021 Pdf 43977

Partial capture of text on file.
                   2021 Kentucky Medicaid ASC Fee Schedule
        Attached is the list of procedure codes that are covered for provider type 36. 
        If the procedure code has an ASC Payment Group the group is listed with the effective date and the allowed amount for the group.
        A reminder, the dental procedure codes have an ASC Payment Group listed, but the reimbursement rule is not set up to use the ASC Payment grou  
        The reimbursement rule is set up to look for a ASD rate (a provider percent rate  found on the provider panel.  
        If the provider does not have a ASD percent rate, default pricing (45% of billed amount) is applied.)
        CODES LISTED WITHOUT A RATE ARE REIMBURSED AT 45% OF BILLED CHARGES.  Code in red end dated as of 12/31/2021 for PT 36
        CDE_                          DSC_PROCEDURE                          EFFECTIVE_       END_DATE       GROUPER        AMT_
        PROC                                                                   DATE                                       PRICE_ASC
        00100      ANESTH SALIVARY GLAND                                     19941213          22991231
        00102      ANESTH REPAIR OF CLEFT LIP                                19941213          22991231
        00103      ANESTH BLEPHAROPLASTY                                     19941213          22991231
        00104      ANESTH ELECTROSHOCK                                       19941213          22991231
        00120      ANESTH EAR SURGERY                                        19941213          22991231
        00124      ANESTH EAR EXAM                                           19941213          22991231
        00126      ANESTH TYMPANOTOMY                                        19941213          22991231
        00140      ANESTH PROCEDURES ON EYE                                  19941213          22991231
        00142      ANESTH LENS SURGERY                                       19941213          22991231
        00144      ANESTH CORNEAL TRANSPLANT                                 19941213          22991231
        00145      ANESTH VITREORETINAL SURG                                 19941213          22991231
        00147      ANESTH IRIDECTOMY                                         19941213          22991231
        00148      ANESTH EYE EXAM                                           19941213          22991231
        00160      ANESTH NOSE/SINUS SURGERY                                 19941213          22991231
        00162      ANESTH NOSE/SINUS SURGERY                                 19941213          22991231
        00164      ANESTH BIOPSY OF NOSE                                     19941213          22991231
        00170      ANESTH PROCEDURE ON MOUTH                                 19941213          22991231
        00172      ANESTH CLEFT PALATE REPAIR                                19941213          22991231
        00174      ANESTH PHARYNGEAL SURGERY                                 19941213          22991231
        00176      ANESTH PHARYNGEAL SURGERY                                 19941213          20211231
        00190      ANESTH FACE/SKULL BONE SURG                               19941213          22991231
                                                      Kentucky Medicaid ASC Fee Schedule
        CODES LISTED WITHOUT A RATE ARE REIMBURSED AT 45% OF BILLED CHARGES.  Code in red end dated as of 12/31/2021 for PT 36
        CDE_                          DSC_PROCEDURE                          EFFECTIVE_       END_DATE       GROUPER        AMT_
        PROC                                                                   DATE                                       PRICE_ASC
        00192      ANESTH FACIAL BONE SURGERY                                19941213          20211231
        00210      ANESTH CRANIAL SURG NOS                                   19941213          22991231
        00214      ANESTH SKULL DRAINAGE                                     19941213          20211231
        00215      ANESTH SKULL REPAIR/FRACT                                 19941213          20211231
        00216      ANESTH HEAD VESSEL SURGERY                                19941213          22991231
        00218      ANESTH SPECIAL HEAD SURGERY                               19941213          22991231
        00220      ANESTH INTRCRN NERVE                                      19941213          22991231
        00222      ANESTH HEAD NERVE SURGERY                                 19941213          22991231
        00300      ANESTH HEAD/NECK/PTRUNK                                   19941213          22991231
        00320      ANESTH NECK ORGAN 1YR/>                                   19941213          22991231
        00322      ANESTH BIOPSY OF THYROID                                  19941213          22991231
        00350      ANESTH NECK VESSEL SURGERY                                19941213          22991231
        00352      ANESTH NECK VESSEL SURGERY                                19941213          22991231
        00400      ANESTH SKIN EXT/PER/ATRUNK                                19941213          22991231
        00402      ANESTH SURGERY OF BREAST                                  19941213          22991231
        00404      ANESTH SURGERY OF BREAST                                  19941213          22991231
        00406      ANESTH SURGERY OF BREAST                                  19941213          22991231
        00410      ANESTH CORRECT HEART RHYTHM                               19941213          22991231
        00450      ANESTH SURGERY OF SHOULDER                                19941213          22991231
        00454      ANESTH COLLAR BONE BIOPSY                                 19941213          22991231
        00470      ANESTH REMOVAL OF RIB                                     19941213          22991231
        00472      ANESTH CHEST WALL REPAIR                                  19941213          22991231
        00474      ANESTH SURGERY OF RIB                                     19941213          20211231
        00500      ANESTH ESOPHAGEAL SURGERY                                 19941213          22991231
        00520      ANESTH CHEST PROCEDURE                                    19941213          22991231
        00522      ANESTH CHEST LINING BIOPSY                                19941213          22991231
        00524      ANESTH CHEST DRAINAGE                                     19941213          20211231
        00528      ANES MEDIASCPY & DX THORSCPY                              19941213          22991231
        00530      ANESTH PACEMAKER INSERTION                                19941213          22991231
        00532      ANESTH VASCULAR ACCESS                                    19941213          22991231
        00534      ANESTH CARDIOVERTER/DEFIB                                 19941213          22991231
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                                                      Kentucky Medicaid ASC Fee Schedule
        CODES LISTED WITHOUT A RATE ARE REIMBURSED AT 45% OF BILLED CHARGES.  Code in red end dated as of 12/31/2021 for PT 36
        CDE_                          DSC_PROCEDURE                          EFFECTIVE_       END_DATE       GROUPER        AMT_
        PROC                                                                   DATE                                       PRICE_ASC
        00540      ANESTH CHEST SURGERY                                      19941213          20211231
        00542      ANESTHESIA REMOVAL PLEURA                                 19941213          20211231
        00546      ANESTH LUNG CHEST WALL SURG                               19941213          20211231
        00548      ANESTH TRACHEA BRONCHI SURG                               19941213          22991231
        00560      ANESTH HEART SURG W/O PUMP                                19941213          20211231
        00562      ANESTH HRT SURG W/PMP AGE 1+                              19941213          20211231
        00580      ANESTH HEART/LUNG TRANSPLNT                               19941213          20211231
        00600      ANESTH SPINE CORD SURGERY                                 19941213          22991231
        00604      ANESTH SITTING PROCEDURE                                  19941213          20211231
        00620      ANESTH SPINE CORD SURGERY                                 19941213          22991231
        00630      ANESTH SPINE CORD SURGERY                                 19941213          22991231
        00632      ANESTH REMOVAL OF NERVES                                  19941213          20211231
        00670      ANESTH SPINE CORD SURGERY                                 19941213          22991231
        00700      ANESTH ABDOMINAL WALL SURG                                19941213          22991231
        00702      ANESTH FOR LIVER BIOPSY                                   19941213          22991231
        00730      ANESTH ABDOMINAL WALL SURG                                19941213          22991231
        00731      ANES UPR GI NDSC PX NOS                                   20180101          22991231
        00732      ANES UPR GI NDSC PX ERCP                                  20180101          22991231
        00750      ANESTH REPAIR OF HERNIA                                   19941213          22991231
        00752      ANESTH REPAIR OF HERNIA                                   19941213          22991231
        00754      ANESTH REPAIR OF HERNIA                                   19941213          22991231
        00756      ANESTH REPAIR OF HERNIA                                   19941213          22991231
        00770      ANESTH BLOOD VESSEL REPAIR                                19941213          22991231
        00790      ANESTH SURG UPPER ABDOMEN                                 19941213          22991231
        00792      ANESTH HEMORR/EXCISE LIVER                                19941213          20211231
        00794      ANESTH PANCREAS REMOVAL                                   19941213          20211231
        00796      ANESTH FOR LIVER TRANSPLANT                               19941213          20211231
        00800      ANESTH ABDOMINAL WALL SURG                                19941213          22991231
        00802      ANESTH FAT LAYER REMOVAL                                  19941213          20211231
        00811      ANES LWR INTST NDSC NOS                                   20180101          22991231
        00812      ANES LWR INTST SCR COLSC                                  20180101          22991231
                                                                           3 of 225
                                                      Kentucky Medicaid ASC Fee Schedule
        CODES LISTED WITHOUT A RATE ARE REIMBURSED AT 45% OF BILLED CHARGES.  Code in red end dated as of 12/31/2021 for PT 36
        CDE_                          DSC_PROCEDURE                          EFFECTIVE_       END_DATE       GROUPER        AMT_
        PROC                                                                   DATE                                       PRICE_ASC
        00813      ANES UPR LWR GI NDSC PX                                   20180101          22991231
        00820      ANESTH ABDOMINAL WALL SURG                                19941213          22991231
        00830      ANESTH REPAIR OF HERNIA                                   19941213          22991231
        00832      ANESTH REPAIR OF HERNIA                                   19941213          22991231
        00840      ANESTH SURG LOWER ABDOMEN                                 19941213          22991231
        00842      ANESTH AMNIOCENTESIS                                      19941213          22991231
        00844      ANESTH PELVIS SURGERY                                     19941213          20211231
        00846      ANESTH HYSTERECTOMY                                       19941213          20211231
        00848      ANESTH PELVIC ORGAN SURG                                  19941213          20211231
        00860      ANESTH SURGERY OF ABDOMEN                                 19941213          22991231
        00862      ANESTH KIDNEY/URETER SURG                                 19941213          22991231
        00864      ANESTH REMOVAL OF BLADDER                                 19941213          20211231
        00865      ANESTH REMOVAL OF PROSTATE                                19960101          20211231
        00866      ANESTH REMOVAL OF ADRENAL                                 19941213          20211231
        00868      ANESTH KIDNEY TRANSPLANT                                  19941213          20211231
        00870      ANESTH BLADDER STONE SURG                                 19941213          22991231
        00872      ANESTH KIDNEY STONE DESTRUCT                              19941213          22991231
        00873      ANESTH KIDNEY STONE DESTRUCT                              19941213          22991231
        00880      ANESTH ABDOMEN VESSEL SURG                                19941213          22991231
        00882      ANESTH MAJOR VEIN LIGATION                                19941213          20211231
        00902      ANESTH ANORECTAL SURGERY                                  19941213          22991231
        00904      ANESTH PERINEAL SURGERY                                   19941213          20211231
        00906      ANESTH REMOVAL OF VULVA                                   19941213          22991231
        00908      ANESTH REMOVAL OF PROSTATE                                19941213          20211231
        00910      ANESTH BLADDER SURGERY                                    19941213          22991231
        00912      ANESTH BLADDER TUMOR SURG                                 19941213          22991231
        00914      ANESTH REMOVAL OF PROSTATE                                19941213          22991231
        00916      ANESTH BLEEDING CONTROL                                   19941213          22991231
        00918      ANESTH STONE REMOVAL                                      19941213          22991231
        00920      ANESTH GENITALIA SURGERY                                  19941213          22991231
        00922      ANESTH SPERM DUCT SURGERY                                 19941213          22991231
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...Kentucky medicaid asc fee schedule attached is the list of procedure codes that are covered for provider type if code has an payment group listed with effective date and allowed amount a reminder dental have but reimbursement rule not set up to use grou look asd rate percent found on panel does default pricing billed applied without reimbursed at charges in red end dated as pt cde dsc grouper amt proc price anesth salivary gland repair cleft lip blepharoplasty electroshock ear surgery exam tympanotomy procedures eye lens corneal transplant vitreoretinal surg iridectomy nose sinus biopsy mouth palate pharyngeal face skull bone facial cranial nos drainage fract head vessel special intrcrn nerve neck ptrunk organ yr thyroid skin ext per atrunk breast correct heart rhythm shoulder collar removal rib chest wall esophageal lining anes mediascpy dx thorscpy pacemaker insertion vascular access cardioverter defib anesthesia pleura lung trachea bronchi w o pump hrt pmp age transplnt spine cord s...
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