Md. Code Regs. 10.09.01.05

Current through Register Vol. 51, No. 11, May 31, 2024

Section 10.09.01.05 - Limitations

Under this chapter, the Program does not cover the following:

A. Services not medically necessary;

B. Services prohibited by the Maryland Nurse Practice Act or by the Board;

C. Advanced practice nursing services included as part of the cost of

(1) An inpatient facility;

(2) A hospital outpatient department; or

(3) A freestanding clinic;

D. Visits by or to the provider solely for the purpose of the following:

(1) Prescription, drug, or food supplement pick-up;

(2) Recording of an electrocardiogram;

(3) Ascertaining the patient's weight;

(4) Interpretation of laboratory tests or panels; or

(5) Prescribing or administering medication;

E. Drugs and supplies which are acquired by the provider at no cost;

F. Injections and visits solely for the administration of injections, unless medical necessity and the patient's inability to take oral medications are documented in the patient's medical record;

G. Services paid under the free-standing dialysis program as described in COMAR 10.09.22;

H. Immunizations required for travel outside the continental United States;

I. Prescriptions and injections for central nervous system stimulants and anorectic agents when used for weight control;

J. Acupuncture;

K. Hypnosis;

L. Travel expenses;

M. Investigational or experimental drugs and procedures;

N. Services denied by Medicare as not medically justified;

O. Specimen collection, except by venipuncture and capillary or arterial puncture, as a separate service;

P. Laboratory or X-ray services performed by another facility, which shall be billed to the Program directly by the facility; and

Q. For certified nurse midwives, a separate visit charge on date of delivery.

Md. Code Regs. 10.09.01.05

Regulation .05G, Q amended effective May 31, 1999 (26:11 Md. R. 854)
Regulations .05B amended effective October 3, 1980 (7:20 Md. R. 1878)
Regulation .05C amended as an emergency provision effective July 1, 1977 (4:12 Md. R. 945); adopted permanently effective September 23, 1977 (4:20 Md. R. 1545); amended as an emergency provision effective November 10, 1977 (4:25 Md. R. 1910); adopted permanently effective March 10, 1978 (5:5 Md. R. 325)
Regulation .05C repealed effective October 3, 1980 (7:20 Md. R. 1878); amended effective 44:17 Md. R. 834, eff. 8/28/2017