Medical, Dental & Pharmacy
- Medical
- Ambulatory Surgical Services
- Children's Services
- Chiropractic
- Clinic Services
- Community First Services and Supports (CFSS)
- Early Intensive Development and Behavioral Intervention (EIDBI)
- Equipment and Supplies
- HCBS
- Hearing Services
- Home Care Services
- Hospice Services
- Hospital Services
- Housing Stabilization Services
- Immunizations and Vaccinations
- Laboratory/Pathology, Radiology, and Diagnostic Services
- Language Interpreter Services
- Long-Term Care
- Medication Reconciliation
- Mental Health Services
- Optical Services
- Personal Care Assistance (PCA) Services
- Physician and Professional Services
- Recuperative Care
- Rehabilitation Services
- Renal Dialysis
- Restricted Recipient Program
- School-Based Community Services
- Substance Use Disorder
- Telehealth Services
- Transportation
- Tribal and Federal Indian Health Services
- Dental
- Pharmacy
Covered Services
Services rendered in an ASC are subject to all applicable PrimeWest Health coverage rules including medical necessity, request for authorization, consent, and second medical opinion.
The following services and supplies are covered as ASC services and included in the PrimeWest Health ambulatory surgery procedure payment. These services and supplies may not be billed separately.
- Use of facility: operating and recovery rooms, patient preparation areas, waiting rooms, and all other areas used by the patient or offered for use by people accompanying the patient
- Nursing and technician services rendered by employees of the ASC (e.g., nurses, technicians, orderlies)
- Drugs, biologicals, surgical dressings, supplies, splints, casts, appliances, and equipment. This category includes all supplies and equipment commonly furnished by the ASC in connection with surgical procedures. Secondary coverings (Ace™ bandages, elastic stockings, spence boots, etc.) are included in the facility services.
- Urinary supplies, such as: collection devices, indwelling and external catheters, any type of drainage bags, leg straps, external urethral clamps, irrigation supplies (bulbs, syringes, tubing, sterile saline or water), insertion trays, and perianal fecal collection pouches
- Primary surgical dressings that are therapeutic and protective coverings applied directly to the skin or on openings to the skin and required as a result of a surgical procedure
- Routine laboratory, X-ray, or other diagnostic tests routinely provided prior to surgery (e.g., urinalysis, hemoglobin, and hematocrit) required by ASC protocol
- Administrative services, record keeping, and housekeeping services necessary to operate the facility (e.g., scheduling, cleaning, utilities, rent)
- Blood, blood plasma, and platelets. Covered procedures are limited to those not expected to result in extensive loss of blood
- Anesthetic and any supplies, whether disposable or reusable, necessary for its administration
- Post-anesthesia observation and post-emergency observation
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