DEPARTMENT OF FINANCIAL SERVICES
Division of Worker's Compensation
RULE NO.:RULE TITLE:
69L-7.100Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs)
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 41 No. 85, May 1, 2015 issue of the Florida Administrative Register.
The changes to the proposed rule are being made in response to comments from the Joint Administrative Procedures Committee.
69L-7.100 Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs).
(1) The Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2015 2011 Edition, effective January 1, 2016, http://www.flrules.org/Gateway/reference.asp?No=Ref-00686 (ASC Reimbursement Manual) is incorporated by reference as part of this rule. The ASC Reimbursement Manual contains the Maximum Reimbursement Allowances determined by the Three-Member Panel, pursuant to subsection Section 440.13(12), F.S., and establishes reimbursement policies, guidelines, codes and maximum reimbursement allowances (MRAs) for items and services provided to an injured worker in connection with a surgical procedure performed in an Ambulatory Surgical Center.
(2) The ASC Reimbursement Manual refers to a number of procedure codes and modifiers that are consistent with the Current Procedural Terminology (CPT®), developed and published by the American Medical Association. When a service or procedure is performed that does not have a code listed in the ASC Reimbursement Manual, the Ambulatory Surgical Center shall refer to the Current Procedural Terminology (CPT®), 2015 2010 Professional Edition, Copyright 2014 2009, American Medical Association, which is hereby incorporated by reference as part of this rule. The CPT® Assistant, Copyright American Medical Association, Copyright 2015; the 2015 ICD-9-CM Professional Edition for Hospitals, Volumes 1, 2 & 3, American Medical Association, Copyright 2015; the 2015 ICD-9-CM Professional Edition for Physicians, Volumes 1 & 2, American Medical Association, Copyright 2015; the 2015 ICD-10-CM: The Complete Official Draft Codebook, American Medical Association, Copyright 2014 OptumInsight, Inc.; and the 2015 ICD-10-PCS: The Complete Official Draft Codebook, American Medical Association, Copyright 2014 OptumInsight, Inc. are also incorporated by reference as part of this rule. A copy of these reference materials may be obtained from the American Medical Association’s website at https://commerce.ama-assn.org/store/. In addition, the rule incorporates the 2010 ICD-9-CM for Hospitals, Volumes 1, 2 and 3, International Classification of Diseases, 9th Revision, Clinical Modification, Copyright 2009, Ingenix, Inc.; the Physician ICD-9-CM 2010, Volumes 1 & 2, International Classification of Diseases, 9th Revision, Clinical Modification, Copyright 2009, Ingenix, Inc.
(3) The CDT 2015, Dental Procedure Codes Current Dental Terminology (CDT-2009/2010), Copyright 2014 2008, American Dental Association, is and the HCPCS Level II, A resourceful complication of HCPCS codes 2010, Copyright 2009, Ingenix Publishing Group, are incorporated by reference as part of this rule, for dental D codes, injectable J codes, and other medical services or supply codes as specified in the ASC Reimbursement Manual. A copy of the CDT reference material may be obtained from the American Dental Association’s website at http://www.ada.org/en/publications/ada-catalog.
(4) The ASC Reimbursement Manual and copies of materials incorporated by reference in this rule are available for inspection during normal business hours at the Florida Department of Financial Services, Document Processing Section, 200 East Gaines Street, Tallahassee, Florida 32399-0311, or via the Department’s website web site at http://www.myfloridacfo.com/Division/wc/
http://www.myfloridacfo.com/wc/ provider/reimbursement-manuals.html.
Rulemaking Authority 440.13(4),(13) (14), 440.591 FS. Law Implemented 440.13(7), (12),(13) (14) FS. History–New 8-7-91, Amended 12-31-92, Formerly 38F-7.100, 4L-7.100, Amended 9-4-05, 8-19-07, 11-13-11, ___________.
