405 IAC 5-12-2 - Office visits

Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2; IC 12-15-21-3

Affected: IC 12-13-7-3; IC 12-15; IC 25-10-1-1

Sec. 2.

Medicaid reimbursement is available for chiropractic office visits and spinal manipulation treatments or physical medicine treatments, subject to the following restrictions:

(1) Reimbursement is limited to a total of fifty (50) office visits or treatments per member per year, which includes a maximum reimbursement of no more than five (5) office visits per member per year.

(2) Reimbursement is not available for the following types of extended or comprehensive office visits:

(A) New patient detailed.

(B) New patient comprehensive.

(C) Established patient detailed.

(D) Established patient comprehensive.

(3) New patient office visits are reimbursable only once per provider per lifetime of the member. As used in this section, "new patient" means one who has not received any professional services from the provider or another provider of the same specialty who belongs to the same group practice within the past three (3) years.

Notes

405 IAC 5-12-2

Office ofthe Secretary of Family and Social Services; 405 IAC 5-12-2; filed Jul 25, 1997, 4:00p.m.: 20 IR 3314; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; filed May 1, 2003, 10:45 a.m.: 26 IR 2861; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA Filed 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRA Readopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFA Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA