405 Ind. Admin. Code 5-8-4

Current through December 4, 2024

Section 405 IAC 5-8-4 - Confirmatory consultations

Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2

Affected: IC 12-13-7-3; IC 12-15

Sec. 4.

(a) A confirmatory consultation is the rendering of a second or third medical opinion, completed by a physician for a specific member, regarding evaluation or management of a condition.

(b) A confirmatory consultation may be billed to Medicaid only when it is specifically requested by another physician or the office.

(c) A confirmatory consultation to substantiate that the service is medically necessary may be required as part of the prior authorization process.

405 IAC 5-8-4

Office ofthe Secretary of Family and Social Services; 405 IAC 5-8-4; filed Jul 25, 1997, 4:00p.m.: 20 IR 3310; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA

Filed 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRA

Errata filed 11/1/2016, 9:36 a.m.: 20161109-IR-405160493ACA

Readopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFA

Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA