Md. Code Regs. 10.14.02.15

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

Section 10.14.02.15 - Medical Management Fee

A. A participating health care provider eligible to receive a medical management fee may be one of the following:

(1) Anesthesiologist;

(2) Certified nurse midwife;

(3) Family practitioner;

(4) Gynecologist;

(5) Medical internist;

(6) Medical oncologist;

(7) Nurse anesthetist;

(8) Nurse practitioner;

(9) Pathologist;

(10) Radiation oncologist;

(11) Radiation oncologist;

(12) Radiologist;

(13) Surgeon; and

(14) Participating health care provider who renders services pursuant to §B of this regulation.

B. The Department shall reimburse a participating health care provider as outlined in §A of this regulation a medical management fee of $50 each time a reimbursed service:

(1) Is in compliance with the medical guidelines pursuant to Regulation .04A(7)(a)-(f) of this chapter;

(2) Involves a consult with an oncologist pursuant to Regulation .04A(7)(g) and (h) of this chapter;

(3) Is in compliance with the medical care management guidelines pursuant to Regulation .04A(6) of this chapter; or

(4) Is billed with the medical management fee for reporting and includes a copy of the relevant medical report including, but not limited to:

(a) Radiology;

(b) Biopsy;

(c) Operative; or

(d) Staging.

C. The Program shall reimburse for claims pursuant to this regulation as set forth in Regulation .21 of this chapter.

Md. Code Regs. 10.14.02.15

Regulations. 15 adopted effective December 5, 1994 (21:24 Md. R. 1988)
Regulations .15 amended effective 42:7 Md. R. 569, eff.4/13/2015; amended effective 47:10 Md. R. 515, eff. 5/18/2020