Florida Regulations 69L-7.100 90

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§ Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs).



(1) The Florida Workers� Compensation Reimbursement Manual for Ambulatory Surgical Centers, 1992 Edition, is adopted by reference as part of this rule. The manual contains reimbursement policies and maximum reimbursement allowances for ambulatory surgical facility services, which are items and services provided in connection with a surgical procedure. The manual contains basic instructions and nformation for all ambulatory surgical centers and carriers in the preparation and reimbursement of claims for ambulatory surgical facility services.

(2) The Division has incorporated procedure codes consistent with the American Medical Association�s Current Procedural Terminology (1992 CPT). This publication is adopted by reference as part of this rule. When a procedure is performed which is not listed in the manual, the ambulatory surgical center must use the appropriate code and descriptor contained in the most current copy of the American Medical Association�s Current Procedural Terminology. In such instances, carriers must reimburse ambulatory surgical centers 70% of the ambulatory surgical center�s usual and customary charge. (3) All medical services, which include ambulatory surgical facility services, must be "medically necessary" as defined in Section 440.13, Florida Statutes. Medical services which are of an experimental, investigative or research nature must be approved by the Division of Workers' Compensation prior to authorization by the carrier. (4) The Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers, 1992 Edition, which contains the reimbursement policies and maximum reimbursement allowances for ambulatory surgical facilities, is distributed by the Division of Workers' Compensation, Document Processing Center, 200 East Gaines Street, Tallahassee, Florida 32399-4230. Specific Authority 440.591 FS. Law Implemented 440.09(1), (2), 440.13(1)(a), (b), (d), (g), (h), (2)(a), (d), (e), (h), (j), (3), (4)(a), (b), (f), (g), (h), (i)5., 440.37(2)(a) FS. History�New 8-7-91, Amended 12-31-92, Formerly 38F-7.100, 4L-7.100.