Md. Code Regs. 10.09.09.05

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.09.05 - Limitations

The following are not covered:

A. Services for which the medical laboratory provider cannot supply a properly completed order or standing order identifying the individual practitioner who ordered the laboratory services;

B. Services not adequately documented in the participant's medical records;

C. Services denied by Medicare as not medically necessary;

D. Clinical laboratory services, for which certification by HCFA under CLIA is required, when these services are performed by laboratories that are not certified to perform those services;

E. Procedures that the provider knows or should know are investigational or experimental in nature;

F. Services included by the Program as part of the charge made by an inpatient facility, hospital outpatient department, freestanding clinic, or other Program-recognized entity;

G. Medical laboratory services related to autopsies;

H. Medical laboratory services for which there was insufficient quantity of specimen, improper specimen handling, or other circumstances that would render the results unreliable; and

I. Laboratory services ordered by an:

(1) Individual who is not enrolled as a provider in the Program with an active status on the date of service; and

(2) Entity, facility, or another provider that is not an individual.

Md. Code Regs. 10.09.09.05

Regulation .05 amended effective September 21, 1979 (6:19 Md. R. 1518); August 22, 1988 (15:17 Md. R. 2049); February 6, 1989 (16:2 Md. R. 159)
Regulation .05A and D amended as an emergency provision effective September 16, 1992 (19:20 Md. R. 1812); amended permanently effective January 1, 1993 (19:25 Md. R. 2205)
Regulation .05B repealed effective August 12, 1985 (12:16 Md. R. 1606)
Regulation .05 amended effective September 18, 2000 (27:18 Md. R. 1665)
Regulation .05A amended effective April 29, 2002 (29:8 Md. R. 700); amended effective 43:20 Md. R. 1109, eff. 10/10/2016; amended effective 44:26 Md. R. 1214, eff. 1/1/2018; amended effective 50:14 Md. R. 593, eff. 7/24/2023