Section 146.125  Covered Ambulatory Surgical Treatment Center Services

Effective for dates of service on or after July 1, 2014:

a)         The Department of Healthcare and Family Services will reimburse ambulatory surgical treatment centers (ASTCs) for facility services in accordance with covered enhanced ambulatory patient group (EAPG) services as defined in 89 Ill. Adm. Code 148.140(b)(1).  The Department may exclude from coverage in an ASTC any procedure identified as only appropriate for coverage in a hospital setting.

b)         Facility services furnished by an ASTC include, but are not limited to:

1)         Nursing, technician and related services.

2)         Use of the ASTC facilities.

3)         Supplies (such as drugs, biological products (e.g., blood)), surgical dressings, splints, casts and appliances, and equipment directly related to the provision of surgical procedures.

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.

c)         Facility services do not include items and services for which payment may be made under other provisions of this Section such as physicians' or dentists' services, laboratory, x-ray or diagnostic procedures performed by independent facilities or practitioners on the day of surgery (other than those directly related to performance of the surgical procedure), prosthetic devices, ambulance services, leg, arm, back and neck braces, artificial limbs, and durable medical equipment for use in the patient's home.  In addition, they do not include anesthetist services.

(Source:  Amended at 44 Ill. Reg. 19760, effective December 11, 2020)