Section 405 IAC 5-27-2 - Utilization criteriaAuthority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-13-7-3; IC 12-15
Sec. 2.
Criteria for utilization of radiological services shall include consideration of the following:
(1) Evidence that this radiologic procedure is necessary for the appropriate treatment of illness or injury.(2) X-rays of the spinal column are limited to cases of acute documented injury or a medical condition where interpretation of x-ray films would make a direct impact on the medical/surgical treatment.(3) Medicaid reimbursement is available for x-rays of the extremities and spine for the study of neuromusculoskeletal conditions.(4) Radiologic procedures must be limited to the minimum number of views or films in order to appropriately diagnose or assess a patient condition. Procedures must also be limited to the most appropriate body part or area to provide or rule out a diagnosis for the suspected condition.(5) Medicaid reimbursement is not available for radiology examinations of any body part taken as a routine study not necessary for the diagnosis or treatment of a medical condition.Office ofthe Secretary of Family and Social Services; 405 IAC 5-27-2; filed Jul 25, 1997, 4:00p.m.: 20 IR 3351; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFAFiled 9/11/2019, 9:52 a.m.: 20191009-IR-405180375FRAReadopted filed 11/13/2019, 11:54 a.m.: 20191211-IR-405190487RFAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA