RULE NO: RULE TITLE
59G-4.160: Outpatient Hospital Services

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. 36 No. 21, May 28, 2010 issue of the Florida Administrative Weekly.

The amendment to Rule 59G-4.160, F.A.C., Outpatient Hospital Services, incorporates by reference in rule the Florida Medicaid Hospital Services Coverage and Limitations Handbook, January 2010. The following changes have been made to the handbook.

CHAPTER 2

Page 2-2 Medicaid Reimbursement: Insert the following paragraph prior to Note at the bottom of the page:

In the outpatient hospital setting, the federal Emergency Medical Treatment and Labor Act (EMTALA) screening is reimbursed the Medicaid established technical component of $24, not the line item rate. This service is identified by revenue code 0451 and HCPCS 99281.

APPENDIX B: 045X EMERGENCY ROOM

Page B-7 0450 General Classification: The bullets are changed to read as follows:

● Use General Classification code 0450 when recipients require emergency medical services or emergency treatment beyond the EMTALA emergency medical screening. Code 0450 cannot be used in conjunction with 0451(99281).

● All other appropriate and covered outpatient revenue codes can be billed with 0450 to reflect services rendered to the patient during the course of emergency medical services or emergency treatment.

● No MediPass authorization is required when billing 0450, if the type of admission in Form Locator 14 on the claim is “1” (Emergency). MediPass authorization is required when the condition of the patient is not an emergency.

Page B-8 0451(99281) EMTALA Emergency Medical Screening Services (Effective 7/1/96): The bullets are changed to read as follows:

● Report the EMTALA Medical Screening code 0451 (99281) when no further emergency medical services or emergency treatment are required. If ancillary services are needed to determine if emergency medical services are required, report the ancillary charges using the appropriate revenue center codes in conjunction with code 0451 (99281). Code 0451(99281) cannot be used in conjunction with 0450.

● The federal EMTALA screening is reimbursed the Medicaid established technical component of $24, not the line item rate.

● Effective 10/16/03, HCPCS code 99281 replaces code W1700, used prior to 10/16/03, when billing revenue code 0451.