Outpatient Hospital Services: Provider Reimbursement

The Department will not pay more than the combined payments the provider is allowed to receive from the participants and carriers or intermediaries for providing comparable services under comparable circumstances under Medicare. Providers subject to cost settlement, outpatient hospital services identified below that are not listed in the Department's fee schedules will be reimbursed reasonable costs based on a year-end cost settlement. Maximum payment for hospital-based ambulance services, hospital outpatient diagnostic laboratory and partial care services will be limited to the Department's fee schedule. (7-1-26) 086. – 089. (RESERVED) SUB AREA: AMBULATORY SURGICAL CENTERS (Sections 090-099) 090. – 091. (RESERVED)