7 Alaska Admin. Code § 110.405

Current through May 31, 2024
Section 7 AAC 110.405 - Physician services coverage and limitations
(a) Subject to 7 AAC 110.400 - 7 AAC 110.455, the department will pay a physician who meets the requirements of 7 AAC 110.400 for the following services provided within the scope of the physician's license to practice medicine or osteopathy:
(1) any physician services and supplies necessary for diagnosing and treating illness and injury for which a payment rate has been established by the department that meets the requirements of 7 AAC 145.020;
(2) preventive health screening and treatment provided as part of the EPSDT program under 7 AAC 110.200 - 7 AAC 110.215;
(3) physician services provided in a nursing facility in accordance with 7 AAC 110.410;
(4) sterilization performed by a physician in accordance with 7 AAC 110.415;
(5) a hysterectomy performed by a physician in accordance with 7 AAC 110.420;
(6) speech-language pathology services, if medically necessary;
(7) hearing services, if medically necessary;
(8) a complete vision examination, including a check of refractive state, if a complete vision examination is clinically indicated and the recipient has significant difficulties or complaints related to vision;
(9) anesthesia, if billed in accordance with the American Society of Anesthesiologists' Relative Value Guide, adopted by reference in 7 AAC 160.900;
(10) clinical intervention counseling associated with smoking cessation for no more than 10 sessions per calendar year.
(b) The department will pay a physician for vaccine products and administration, in accordance with 7 AAC 110.750.
(1) the administration of immunizations to a recipient under 21 years of age;
(2) the product and administration of the following vaccines for recipients 19 years of age or older as medically necessary:
(A) Hepatitis A;
(B) Hepatitis B;
(C) Herpes Zoster (Shingles);
(D) Human Papillomavirus;
(E) Measles, Mumps, and Rubella (MMR);
(F) Meningococcal;
(G) Pneumococcal (Polysaccharide);
(H) seasonal Influenza, live attenuated nasal spray or inactivated injection;
(I) Tetanus Diphtheria;
(J) Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis;
(K) Varicella (Chickenpox);
(3) the administration of the following vaccines for a recipient 19 years of age or older as medically necessary:
(A) Influenza A (H1N1) 2009 Monovalent;
(B) Rabies.
(c) The department will pay a physician for providing the following services only if those services are provided to a recipient who is under 21 years of age or who is a Medicare recipient:
(1) chiropractic manipulation;
(2) podiatry services.
(d) The department will not pay for the following services provided by a physician:
(1) elective surgery that is not medically necessary;
(2) infertility services;
(3) case management services;
(4) plastic or cosmetic services for enhancement purposes;
(5) repealed 7/25/2021;
(6) services provided in the operating room on behalf of the physician by a licensed practical nurse, a registered nurse, an intern, or a resident in training used in the operating room;
(7) medical testimony;
(8) travel services;
(9) educational services and supplies;
(10) interpreter services;
(11) experimental or investigative services;
(12) swimming therapy;
(13) programs to improve overall fitness;
(14) impotence treatment or services;
(15) vaccine products that are available free to the provider;
(16) physical examinations, except if
(A) given as a screening under the EPSDT program; or
(B) the department requests one for the purpose of determining eligibility based upon disability, blindness, or pregnancy: or
(C) for recipients 21 years of age and older under 7 AAC 110.800.
(17) selected special services and report codes.

7 AAC 110.405

Eff. 2/1/2010, Register 193; am 6/13/2010, Register 194; am 8/25/2010, Register 195; am 5/1/2016, Register 218, July 2016; am 1/10/2021,Register 237, April 2021; am 7/25/2021, Register 239, October 2021; am 3/3/2023, Register 245, April 2023

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.040