441—78.26 (249A) Ambulatory surgical center services. Ambulatory surgical center services are those services furnished by an ambulatory surgical center in connection with a covered surgical procedure or a covered dental procedure.
Covered surgical procedures shall be those medically necessary procedures that are eligible for payment as physicians’ services, under the circumstances specified in rule 441—78.1(249A) and performed on an eligible recipient, that can safely be performed in an outpatient setting as determined by the department upon advice from the department’s utilization review and quality assurance firm.
Covered dental procedures are those medically necessary procedures that are eligible for payment as dentists’ services, under the circumstances specified in rule 441—78.4(249A) and performed on an eligible recipient, that can safely be performed in an outpatient setting for Medicaid recipients whose mental, physical, or emotional condition necessitates deep sedation or general anesthesia.
The covered services provided by the ambulatory surgical center in connection with a Medicaid-covered surgical or dental procedure shall be those nonsurgical and nondental services covered by the Medicare program as ambulatory surgical center services in connection with Medicare-covered surgical procedures.
	 78.26(1) Abortion procedures are covered only when criteria in subrule 78.1(17) are met.
	 78.26(2) Sterilization procedures are covered only when criteria in subrule 78.1(16) are met.
	 78.26(3) Preprocedure review by the Iowa Foundation for Medical Care (IFMC) is required if ambulatory surgical centers are to be reimbursed for certain frequently performed surgical procedures as set forth under subrule 78.1(19). Criteria are available from IFMC, 3737 Woodland Avenue, Suite 500, West Des Moines, Iowa 50265, or in local hospital utilization review offices. (Cross-reference 78.28(6))
This rule is intended to implement Iowa Code section 249A.4.