405 IAC 5-25-2 - Reimbursement exclusions and limitations
Authority: IC 12-15
Affected: IC 12-13-7-3
Sec. 2.
(a) Medicaid
will not reimburse a physician for the following:
(1) Preparation of reports.
(2) Missed appointments.
(3) Writing or telephoning prescriptions to
pharmacies.
(4) Telephone calls to
laboratories.
(5) Any extra charge
for after-hours services.
(6)
Mileage.
(b) Medicaid
reimbursement is available for a physician as an assistant surgeon with the
following restrictions:
(1) If extenuating
circumstances require an assistant surgeon when customarily one is not
required:
(A) these circumstances must be
well documented in the hospital record; and
(B) documentation must be attached to the
claim form.
(2)
Reimbursement is not available for a surgical assistant who assists in
diagnostic surgical procedures or for minor surgical procedures.
(3) Reimbursement is limited to the
procedures that generally require the skills and services of an assistant
surgeon as set out in HCPCS.
(c) A physician visiting more than one (1)
member in the same long-term care facility on the same day will be reimbursed
for each patient seen in an amount equal to the physician's routine office
service allowance.
(d) Office
visits will be reimbursed up to thirty (30) per calendar year, per member, per
provider. Prior authorization will be given for more frequent visits if
medically necessary.
(e) Any
physician services subject to prior authorization rendered during an office
visit that were not prior authorized will not be reimbursed.
(f) Reimbursement for any physician service
rendered during an office visit that is subsequently found not be medically
necessary is subject to recoupment.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.