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Mississippi Division of Medicaid AMBULATORY SURGICAL CENTERS (ASC) FEE SCHEDULE COVER SHEET

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Mississippi Division of Medicaid AMBULATORY SURGICAL CENTERS (ASC) FEE SCHEDULE COVER SHEET Mississippi Division of Medicaid AMBULATORY SURGICAL CENTERS (ASC) FEE SCHEDULE COVER SHEET Additional References: MS Division of Medicaid Website MS Envision Interactive Fee Schedule MS Envision Downloadable Fee Schedule Medicaid National Correct Coding Initiative (NCCI) Edits Note Number Column Title Details • Healthcare Common Procedure Coding System (HCPCS) or Current Procedural 1 Code Terminology (CPT) Code • Short Descriptor for the Healthcare Common Procedure Coding System (HCPCS) or 2 Description Current Procedural Terminology Code Clinical Description 3 Min Age • This column is the covered minimum age for the service. 4 Max Age • This column is the covered maximum age for the service. • This column represents the begin date of which the fee in columns H became effective. 5 Begin Date 6 End Date • This column represents the end date of the fee segment in columns H. • This column represents the maximum units the Division of Medicaid covers for the 7 Max Units service. • This column is the maximum amount that Division of Medicaid will pay for each unit. 8 Fee • When the is maximum fee is listed as 0.00, the service is a packaged service/item, no separate payment made. • This column is the maximum amount less the 5% reduction required by Miss. Code Ann. §43-13-117(B) that the Division of Medicaid will pay for each unit. 9 Fee Reduced • When the maximum fee is listed as 0.00, the service is a packaged service/item, no separate payment made. Mississippi Division of Medicaid AMBULATORY SURGICAL CENTERS (ASC) WEBSITE FEE SCHEDULE Print Date: JULY 1, 2021 The fee schedules located on the Mississippi Medicaid website are prepared to assist Medicaid providers and are not intended to grant rights or impose obligations. Every effort is made to assure the accuracy of the information within the fee schedules as of the date they are printed. Medicaid makes no guarantee that this compilation of fee schedule information is error-free and will bear no responsibility or liability for the results or consequences of the use of these schedules. Fee schedules are posted for informational purposes only and do not guarantee reimbursement. Fees are subject to the rules and requirements of the Division of Medicaid, Federal and State law. **All services and maximums allowed quantities are subject to NCCI procedure-to-procedure or medically unlikely editing even if prior authorized.** The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright© 2020 American Medical Association and © 2020 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply. Max Code Description Min Age Max Age Begin Date End Date Fee Units 10004 FNA BX W/O IMG GDN EA ADDL 0 999 1/1/2019 12/31/9999 3 0.00 10005 FNA BX W/US GDN 1ST LES 0 999 10/1/2020 12/31/9999 1 60.06 10006 FNA BX W/US GDN EA ADDL 0 999 1/1/2019 12/31/9999 3 0.00 10007 FNA BX W/FLUOR GDN 1ST LES 0 999 10/1/2020 12/31/9999 1 185.94 10008 FNA BX W/FLUOR GDN EA ADDL 0 999 1/1/2019 12/31/9999 3 0.00 10009 FNA BX W/CT GDN 1ST LES 0 999 10/1/2020 12/31/9999 1 246.58 10010 FNA BX W/CT GDN EA ADDL 0 999 1/1/2019 12/31/9999 3 0.00 10021 FNA W/O IMAGE 0 999 10/1/2020 12/31/9999 1 47.35 10030 IMAGE FLUID COLL/CATHETER 0 999 10/1/2020 12/31/9999 1 246.58 10035 PERQ DEV SOFT TISS 1ST IMAG 0 999 1/1/2016 12/31/9999 1 0.00 10036 PERQ DEV SOFT TISS ADD IMAG 0 999 1/1/2016 12/31/9999 1 0.00 10060 INCISION/ DRAINAGE SIMPLE OR SINGLE 0 999 10/1/2020 12/31/9999 1 60.34 10061 INCISN/ DRAIN COMPLICTD OR MULT 0 999 10/1/2020 12/31/9999 1 92.39 10080 *INCISION AND DRAINAGE OF PIL 0 999 10/1/2020 12/31/9999 1 132.23 10081 INCISION AND DRAINAGE OF PIL 0 999 10/1/2020 12/31/9999 1 166.88 10120 INCISION AND REMOVAL OF FORE 0 999 10/1/2020 12/31/9999 1 85.46 10121 INCIS/ REMO FOR, SUBCUT TISS; COMPLICTD 0 999 10/1/2020 12/31/9999 1 461.11 10140 INCISION AND DRAINAGE OF HEMAT 0 999 10/1/2020 12/31/9999 1 88.06 10160 *PUNCTURE ASPIRATION OF ABSCE 0 999 10/1/2020 12/31/9999 1 66.70 10180 INC/DRAGE, COPLX, POSTOP WOUND INFEC 0 999 10/1/2020 12/31/9999 1 795.47 11000 DEBRI OF ECZE; UP 10% OF BODY SUR 0 999 10/1/2020 12/31/9999 1 27.43 11001 DEBRIDE INFECT SKIN ADD-ON 0 999 10/1/2014 12/31/9999 10 0.00 11010 DEBRIDE SKIN AT FX SITE 0 999 10/1/2020 12/31/9999 1 246.58 11011 DEBRIDE SKIN MUSC AT FX SITE 0 999 10/1/2020 12/31/9999 1 246.58 11012 DEB SKIN BONE AT FX SITE 0 999 10/1/2020 12/31/9999 1 795.47 11042 DEB SUBQ TISSUE 20 SQ CM/< 0 999 10/1/2020 12/31/9999 1 129.16 11043 DEB MUSC/FASCIA 20 SQ CM/< 0 999 10/1/2020 12/31/9999 1 200.91 11044 DEB BONE 20 SQ CM/< 0 999 10/1/2020 12/31/9999 1 461.11 11045 DBRDMT SUBQ TISSUE EA ADDL 20 SQ CM 0 999 10/1/2014 12/31/9999 19 0.00 11046 DBRDMT M&/F EA ADDL 20 SQ CM 0 999 10/1/2014 12/31/9999 19 0.00 11047 DEBRIDEMENT BONE EA ADDL 20 SQ CM/< 0 999 10/1/2014 12/31/9999 19 0.00 11055 PAR BEN HYPKE; SING LESION 0 999 10/1/2015 12/31/9999 1 0.00 11056 PAR BEN HYPKE; 2 TO 4 LESION 0 999 10/1/2016 12/31/9999 1 0.00 11057 PAR BEN HYPKE; MOR THAN 4 LESIONS 0 999 10/1/2020 12/31/9999 1 46.48 11102 TANGNTL BX SKIN SINGLE LES 0 999 10/1/2020 12/31/9999 1 60.63 11103 TANGNTL BX SKIN EA SEP/ADDL 0 999 1/1/2019 12/31/9999 6 0.00 11104 PUNCH BX SKIN SINGLE LESION 0 999 10/1/2020 12/31/9999 1 70.63 11105 PUNCH BX SKIN EA SEP/ADDL 0 999 1/1/2019 12/31/9999 3 0.00 11106 INCAL BX SKN SINGLE LES 0 999 10/1/2020 12/31/9999 1 92.97 11107 INCAL BX SKN EA SEP/ADDL 0 999 1/1/2019 12/31/9999 2 0.00 11200 REMO OF TAGS; UP TO INCLD 15 LESIONS 0 999 10/1/2015 12/31/9999 1 0.00 11201 REMOVE SKIN TAGS ADD-ON 0 999 10/1/2014 12/31/9999 1 0.00 11300 SHAV DRM TRK, AR, LEG; LES DIA 0.5CM /LE 0 999 10/1/2016 12/31/9999 15 0.00 11301 SHAV DRM TRK, AR, LEG; LES DIA 0.6/1.0CM 0 999 10/1/2016 12/31/9999 15 0.00 11302 SHAV DRM TRK, AR, LEG; LES DIA 1.1/2.0CM 0 999 10/1/2016 12/31/9999 15 0.00 11303 SHAV DRM TRK, AR, LEG; LES DIA OVR 2.0CM 0 999 10/1/2016 12/31/9999 15 0.00 11305 SHAV DRM SCA,NK,HD,FE, GEN;LES 0.5/LESS 0 999 10/1/2015 12/31/9999 15 0.00 11306 SHAV DRM SCA,NK,HD,FE, GEN;LES 0.6/1.0CM 0 999 10/1/2016 12/31/9999 15 0.00 11307 SHAV DRM SCA,NK,HD,FE, GEN;LES 1.1/2.0CM 0 999 10/1/2020 12/31/9999 15 70.63 11308 SHAV DRM SCA,NK,HD,FE, GEN;LES OVR 2.0 C 0 999 10/1/2016 12/31/9999 15 0.00 11310 SHAV DRM FA, EA,EYL,NO,LI, MU; 0.5CM/LES 0 999 10/1/2020 12/31/9999 15 69.30 11311 SHAV DRM FA, EA,EYL,NO,LI, MU; 0.6/1.0CM 0 999 10/1/2020 12/31/9999 15 70.63 11312 SHAV DRM FA, EA,EYL,NO,LI, MU; 1.1/2.0CM 0 999 10/1/2020 12/31/9999 15 88.93 11313 SHAV DRM FA, EA,EYL,NO,LI, MU; OVR 2.0CM 0 999 10/1/2020 12/31/9999 15 98.46 11400 EXC, LES, TRK,AR,LE; EXC 0.5CM OR LESS 0 999 10/1/2020 12/31/9999 15 73.91 11401 EXC, LES, TRK,AR,LE; EXC 0.6 TO 1.0 CM 0 999 10/1/2020 12/31/9999 10 84.30 11402 EXC, LES, TRK,AR,LE; EXC 1.1 TO 2.0 CM 0 999 10/1/2020 12/31/9999 5 92.10 Page 2 of 66 Mississippi Division of Medicaid AMBULATORY SURGICAL CENTERS (ASC) WEBSITE FEE SCHEDULE Print Date: JULY 1, 2021 The fee schedules located on the Mississippi Medicaid website are prepared to assist Medicaid providers and are not intended to grant rights or impose obligations. Every effort is made to assure the accuracy of the information within the fee schedules as of the date they are printed.
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