Ambulatory Surgical Centers - Chapter 29 - Requirements for Medicaid Reimbursement

Oct 28, 2026

Chapter Twenty-Nine of the Louisiana Medicaid Services Manual outlines the ambulatory surgery program for eligible beneficiaries whose surgical care does not require hospitalization and is expected to last no more than 24 hours after admission. It defines covered ASC services, details exclusions (including what is not considered ASC services), and specifies provider and operational requirements. The chapter also explains reimbursement structures, flat fee facility charges, billing considerations, and “never events” situations where payment will not be provided.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages22

Reading Time55 min

AccessFree to download

Overview

Covered Services

Exclusions

Provider Requirements

Reimbursement

Never Events

Claims Filing

AMBULATORY SURGICAL CENTERS Chapter Twenty-Nine of the Medicaid Services Manual Issued November 1, 2010 Claims/authorizations for dates of service on or after October 1, 2015 must use the applicable ICD-10 diagnosis code that reflects the policy intent. References in this manual to ICD-9 diagnosis codes only apply to claims/authorizations with dates of service prior to October 1, 2015. State of Louisiana Bureau of Health Services Financing AMBULATORY SURGICAL CENTERS TABLE OF CONTENTS SUBJECT SECTION OVERVIEW COVERED SERVICES Exclusions PROVIDER REQUIREMENTS REIMBURSEMENT Never Events Billing CONTACT INFORMATION CLAIMS FILING SECTION 29.0 SECTION 29. 1 SECTION 29.2 SECTION 29.3 APPENDIX A APPENDIX B OVERVIEW The Medicaid Ambulatory Surgery Program provides surgical services to eligible Medicaid beneficiaries not requiring hospitalization and which the expected duration of services would not exceed 24 hours following an admission. Services are provided at an ambulatory surgical center (ASC) which is a free-standing facility, separate from a hospital, which meets the needs of the eligible beneficiary for minor surgery. The purpose of this chapter is to set forth the conditions and requirements an ASC must meet in order to qualify for reimbursement under the Louisiana Medicaid program. The manual is intended to make available to Medicaid providers ofASCs a ready reference for information and procedural material needed for the prompt and accurate filing of claims for services furnished to Medicaid beneficiaries. The Louisiana Department of Health (LDH), Bureau of Health Services Financing (BHSF), Program Operations Section is responsible for assuring provider compliance with these regulations. COVERED SERVICES An ambulatory surgical center (ASC) is any distinct entity that operates exclusively for the purpose of providing surgical services to beneficiaries not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following an admission. The services must be medically necessary, preventive, diagnostic, therapeutic, rehabilitative or palliative services furnished to an outpatient by or under the direction of a physician or dentist in a facility which is not part of a hospital but is organized and operated to provide medical care to beneficiaries. ASC services are items and services furnished by an outpatient ASC in connection with a covered surgical procedure. Covered services include, but are not limited to, the following: 1. Nursing, technician and related services; 2. Use of an ASC; 3. Laboratory and x-ray, drugs, biologicals, surgical dressings, splints, casts, 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, record keeping, and housekeeping items and services; 6. Materials for anesthesia; 7. Intra-ocular lenses; and 8. Supervision of the services of an anesthetist by the operating surgeon. Exclusions Items and services for which payment maybe made under other provisions are excluded from ASC services. The following are not included in ASC services: 1. Physician services; 2. Laboratory and x-ray not directly related to the surgical procedure; 3. Diagnostic procedures (other than those directly related to performance of the surgical procedure); 4. Prosthetic devices (except intraocular lens implant); 5. Ambulance services; 6. Leg, arm, back, and neck braces; 7. Artificial limbs; 8. Durable medical equipment (DME) for use in the patient's home; and 9. Chronic pain management. NOTE: Funds reimbursed for the purpose of chronic pain management, are subject to recoupment. PROVIDER REQUIREMENTS Ambulatory surgical centers (ASCs) must have an agreement with the Centers for Medicare and Medicaid Services (CMS) and be enrolled a

FAQs

What qualifies a service for the Louisiana Medicaid Ambulatory Surgery Program?

The beneficiary must not require hospitalization, and the expected duration of services must not exceed 24 hours following an admission. Services must be medically necessary (or preventive, diagnostic, therapeutic, rehabilitative, or palliative) and provided by or under the direction of a physician or dentist at a qualifying free-standing facility.

Which items and services are excluded from ASC services?

Excluded items and services include physician services, lab and x-ray not directly related to the surgical procedure, unrelated diagnostic procedures, prosthetic devices except intraocular lens implants, ambulance services, certain braces and artificial limbs, home-use durable medical equipment, and chronic pain management (with note that related funds may be recouped).

How does reimbursement work for ambulatory surgical center procedures?

Reimbursement uses a flat fee per service according to Medicaid ambulatory surgery payment groups on the fee schedule. The flat fee covers facility charges and operative functions, but excludes payments for the surgeon, radiologist, and anesthesiologist when they are not under contract with the ASC.

Oct 28, 2026

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