Md. Code Regs. 10.09.64.05

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.64.05 - Limitations

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

A. Services not specified in Regulation .03 of this chapter;

B. Services not medically necessary;

C. Services prohibited by the Maryland Nurse Practice Act or by the State Board of Nursing;

D. 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;

E. 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;

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

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

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

I. Acupuncture;

J. Hypnosis;

K. Travel expenses;

L. Investigational or experimental drugs and procedures;

M. Services denied by Medicare as not medically justified;

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

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

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

Md. Code Regs. 10.09.64.05

Regulations .05 adopted as an emergency provision effective November 8, 1996 (23:25 Md. R. 1730)
Regulations .05 adopted effective March 10, 1997 (24:5 Md. R. 408)
Regulation .05 amended effective October 28, 2013 (40:21 Md. R. 1775); February 16, 2015 (42:3 Md. R. 316)
Regulation .05A amended effective December 27, 2010 (37:26 Md. R. 1787)
Regulation .05 amended effective 42:23 Md. R. 1434, eff.2/1/2016; amended effective 45:26 Md. R. 1244, eff. 12/31/2018; recodified to 10.67.03.05 effective 46:22 Md. R. 976, eff. 11/1/2019; adopted effective 51:15 Md. R. 707, eff. 8/5/2024.