Section 20-2-II - SERVICES THAT MAY REQUIRE PRE-CERTIFICATIONThe following medical procedures may require pre-certification by the payer. The payer may, at its discretion, require review by a utilization review agent. If a utilization review agent is not used, the review must be based on evidence-based practice standards. Any adverse determination must have concurrence of a physician of the same specialty and licensed to practice in Mississippi. If the payer requires review by a utilization review agent and receives an adverse determination, the payer may override the decision and authorize the series(s).
A. Physical medicine treatments after and 15 visits and/or 30 days post-operatively; B. Rental or purchase of supplies or equipment over the amount of $300.00 per item; C. Rental or purchase of TENS; E. Pain clinic/therapy programs, including interdisciplinary pain rehabilitation programs; F. External spinal stimulators;G. Pain control programs; H. Work hardening programs, functional capacity testing, ISO kinetic testing;I. Orthotics or prosthetics; J. Psychological testing/counseling/treatment; K. Substance abuse program; L. Weight reduction program; M. Any non-emergency medical service outside the State of Mississippi; N. Repeat MRI, repeat CT scan, repeat EMG/NCS, and repeat myelogram (more than once per injury and/or more than one post-operatively); and O. Massage therapy, acupuncture and biofeedback.