20 Miss. Code. R. 2-II - SERVICES THAT MAY REQUIRE PRE-CERTIFICATION

The following medical procedures may require pre-certification by the payer. The payer may, at its discretion, require review by a utilization review agent. If a utilization review agent is not used, the review must be based on evidence-based practice standards. Any adverse determination must have concurrence of a physician of the same specialty and licensed to practice in Mississippi. If the payer requires review by a utilization review agent and receives an adverse determination, the payer may override the decision and authorize the series(s).

A. Physical medicine treatments after and 15 visits and/or 30 days post-operatively;

B. Rental or purchase of supplies or equipment over the amount of $300.00 per item;

C. Rental or purchase of TENS;

D. Home health services;

E. Pain clinic/therapy programs, including interdisciplinary pain rehabilitation programs;

F. External spinal stimulators;

G. Pain control programs;

H. Work hardening programs, functional capacity testing, ISO kinetic testing;

I. Orthotics or prosthetics;

J. Psychological testing/counseling/treatment;

K. Substance abuse program;

L. Weight reduction program;

M. Any non-emergency medical service outside the State of Mississippi;

N. Repeat MRI, repeat CT scan, repeat EMG/NCS, and repeat myelogram (more than once per injury and/or more than one post-operatively); and

O. Massage therapy, acupuncture and biofeedback.

Notes

20 Miss. Code. R. 2-II

Amended 6/15/2019