Md. Code Regs. 10.09.09.05 - Limitations
The following are not covered:
A. Services for which the medical laboratory
provider cannot supply a properly completed order or standing order identifying
the individual practitioner who ordered the laboratory services;
B. Services not adequately documented in the
participant's medical records;
C.
Services denied by Medicare as not medically necessary;
D. Clinical laboratory services, for which
certification by HCFA under CLIA is required, when these services are performed
by laboratories that are not certified to perform those services;
E. Procedures that the provider knows or
should know are investigational or experimental in nature;
F. Services included by the Program as part
of the charge made by an inpatient facility, hospital outpatient department,
freestanding clinic, or other Program-recognized entity;
G. Medical laboratory services related to
autopsies;
H. Medical laboratory
services for which there was insufficient quantity of specimen, improper
specimen handling, or other circumstances that would render the results
unreliable; and
I. Laboratory
services ordered by an:
(1) Individual who is
not enrolled as a provider in the Program with an active status on the date of
service; and
(2) Entity, facility,
or another provider that is not an individual.
Notes
Regulation .05A and D amended as an emergency provision effective September 16, 1992 (19:20 Md. R. 1812); amended permanently effective January 1, 1993 (19:25 Md. R. 2205)
Regulation .05B repealed effective August 12, 1985 (12:16 Md. R. 1606)
Regulation .05 amended effective September 18, 2000 (27:18 Md. R. 1665)
Regulation .05A amended effective April 29, 2002 (29:8 Md. R. 700); amended effective 43:20 Md. R. 1109, eff.
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