South Carolina: Commission adjusts fee schedule for surgery centers
The maximum allowable payment for procedures performed in an ambulatory surgery center will be calculated at 140 percent of the Medicare payment for procedures plus the total cost of all surgical implants per case with certain revenue codes minus a $500 implant cost reduction per case. In order to receive reimbursement, the surgery center must provide a copy of the original manufacturer's wholesale invoice at the time of billing. The surgery center must adjust the manufacturer's invoice to reflect all applicable rebates, discounts, offsets, considerations, volume pricing, refunds, and product replacement programs, and documentation must be provided as a condition for payment for the implant. The revised fee schedule provides a definition for surgical implants. The fee schedule went into effect on April 15.
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May 13, 2013
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