Current through Register Vol. 48, No. 51, June 17, 2024
Part 9505.5045 - CRITERIA TO DETERMINE WHEN SECOND MEDICAL OPINION IS REQUIRED The commissioner shall use the criteria in items A to D to determine which surgical procedures shall be subject to the second medical opinion requirement.
A. Authoritative medical literature identifies the surgical procedure as being overutilized.B. The surgical procedure is shown to be utilized to a greater degree within the Medicaid population than in the non-Medicaid population.C. The utilization or cost of a surgical procedure falls within the top ten percent of all surgical procedures reimbursed under the MA and GAMC programs.D. Alternative methods of treatment which are less intrusive are available.Statutory Authority: MS s 256.0625; 256.991; 256D.03