23 Miss. Code. R. 203-1.4 - Physician Office Visits
A. The Division of
Medicaid covers a combined total of sixteen (16) non-psychiatric physician
office and hospital outpatient department visits per state fiscal year whether
occurring during or after office hours or provider established office hours.
[Refer to Miss. Admin. Code, Part 200, Rule
9.5 for psychiatric physician office
and hospital outpatient department visits.]
B. The Division of Medicaid:
1. Defines regularly scheduled office hours
as the hours between 8:00 a.m. and 5:00 p.m., Monday through Friday, excluding
Saturday, Sunday and federal and state holidays, referred to in Rule 1.4 as
"office hours".
2. Permits
providers to set regularly scheduled office hours outside of the Division of
Medicaid's definition of office hours, referred to in Rule 1.4 as "provider
established office hours".
3.
Requires providers to maintain records indicating the provider's established
office hours and any changes including:
a) The
date of the change,
b) The provider
established office hours prior to the change, and
c) The new provider established office
hours.
C. The
Division of Medicaid reimburses a fee in addition to the appropriate Evaluation
and Management (E&M) code for a physician office visit when the visit:
1. Occurs during the provider established
office hours which are set outside of the Division of Medicaid's definition of
office hours, or
2. Occurs outside
of office hours or provider established office hours only for a condition which
is not life-threatening but warrants immediate attention and cannot wait to be
treated until the next scheduled appointment during office hours or provider
established office hours.
D. The Division of Medicaid reimburses only
the appropriate E&M code for a physician office visit scheduled during
office hours or provider established office hours but not occurring until after
office hours or provider established office hours.
E. The Division of Medicaid reimburses
physician visits related to opioid treatment as part of a monthly bundle.
1. Physicians that are providing office based
opioid treatment must be appropriately licensed and operating within the scope
of their practice.
2. Physician
visits provided as part of the office based opioid treatment bundle do not
count toward the physician visit limit.
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.