04/23/2010

Medicaid Updates Codes and Fee Schedule

The Ohio Department of Job and Family Services recently updated some codes to reflect coding changes and fees based on the Ohio state budget for ASC procedures.

The coding changes corrects problems in the coding system that was denying certain pain management claims.

The fee schedule update lowers the Medicaid reimbursement by 3% for all providers. This was suppose to take effect on 1/1/2001 but will now be effective 4/13/2010.

ODJFS MEMO

Ohio has recently implemented some coverage and pricing updates for Ambulatory Surgery Centers.  ODJFS has added the ASC indicator of "1" to CPT codes 64490, 64491, 64492, 64493, 64494 & 64495  so that claims from ASCs submitted with 01/01/2010 dates of service forward will be paid at the ASC rate for the codes they have replaced (64470,64472,64475 & 64476).

They have also adjusted our ASC rates to reflect the 3% provider fee decrease that was put into effect on 01/01/2010.  This change will most likely go into effect on April 13, 2010.  The adjusted rates are as follows:

Indicator                  Old                   New

1                        254.41                  246.78

2                        341.96                  331.70

3                        392.43                  380.66

4                        483.07                  468.58

5                        551.05                  534.52

6                        726.15                  704.37

7                        765.29                  742.33

8                        838.42                  813.27

9                      1063.99                1032.07