ASC Fee Schedule Effective January 1, 2008

The Oklahoma State and Education Employees Group Insurance Board (OSEEGIB) has reviewed the changes to ASC reimbursements made by CMS effective January 1, 2008. OSEEGIB will use the existing Ambulatory Surgery Center Provider Contract and incorporate CMS's changes as follows:

• Since the present Provider Contract makes reference to "ASC Payment Groups" (Groups as defined by CMS and Custom Groups as defined by OSEEGIB) to determine fees, OSEEGIB has reworked its Groups to include substantially all of the CPT/HCPCS codes that CMS now includes.
• One exception to the inclusion of CPT/HCPCS codes is "C" codes, which are non-covered items/services.
• OSEEGIB now has 98 Custom Groups with fees ranging from $1.00 to $21,000.00.
• OSEEGIB allowables are approximately 180% to 200% of CMS fees.
• OSEEGIB will not use transitional pricing; allowables are calculated on the "Fully Implemented Payment" rate provided by CMS.
• OSEEGIB will continue to pay for implants at cost plus 10%, as billed by providers. Because CMS priced some procedures to include the cost of implants, OSEEGIB allowables were adjusted where necessary to include only the portion of the CMS fee attributable to the procedure.

     
     ASC Fee Schedule 1-1-08

     Implants 1-1-08

     Groupers and Fees 1-1-08