(1) Reimbursement of the provider based entity facility component will be on a rate-per-service basis using the outpatient prospective payment system (OPPS) schedules or Medicare fee schedules as in ARM 37.86.3007, 37.86.3016, 37.86.3018, 37.86.3020, and 37.86.3025 except as follows:

(a) Provider based entity facility component billed under revenue code 510 will be reimbursed at 80% of the applicable rate.

(b) The facility component of provider based entities provided by exempt hospitals or critical access hospitals as defined in ARM 37.86.2901(4) and (8) will be interim reimbursed a hospital specific outpatient cost to charge ratio.

(2) Reimbursement of the provider based entity professional component will be reimbursed as provided in ARM 37.86.105, 37.86.205, 37.86.506, 37.88.206, and 37.88.606.

(3) Provider based entity facilities must bill using revenue code 510 for CPT codes for Evaluation and Management services (E and M codes) and procedural codes as per Medicare guidelines in Chapter III and in Appendix 3 of the Uniform Billing Editor. HCPCS/CPT codes must be mapped to the 510 revenue code when the procedure was performed in a provider based clinic setting unless Medicare issued instructions for use of another revenue code.

(4) Provider based entity professionals must bill using the correct site-of-service so that appropriate payment amounts may be determined as in ARM 37.86.105, 37.86.205, 37.86.506, 37.88.206, and 37.88.606.

(a) Unless otherwise noted, only CPT codes for Evaluation and Management services, professional components, and procedural codes may be billed for professional reimbursement in provider based entities.

(i) All other billable supplies, injectibles, drugs, imaging, diagnostics, lab, and any other services must be billed under the appropriate revenue code using the provider based entity facility provider number.

(5) Provider based entities providing obstetric services (which may include antepartum, delivery, and/or postpartum) must bill as a nonprovider based provider.

(6) Vaccines For Children (VFC) services must bill as a nonprovider based provider.