Regulation .05 Limitations.
Regulation .05 Limitations.LinkCopy Citation
Under this chapter, the Program does not cover the following:
A.
Services not medically necessary;
B.
Services prohibited by the Maryland Nurse Practice Act or by the Board;
C.
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;
D.
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;
E.
Drugs and supplies which are acquired by the provider at no cost;
F.
Injections and visits solely for the administration of injections, unless medical necessity and the patient's inability to take oral medications are documented in the patient's medical record;
G.
Services paid under the free-standing dialysis program as described in COMAR 10.09.22;
H.
Immunizations required for travel outside the continental United States;
I.
Prescriptions and injections for central nervous system stimulants and anorectic agents when used for weight control;
J.
Acupuncture;
K.
Hypnosis;
L.
Travel expenses;
M.
Investigational or experimental drugs and procedures;
N.
Services denied by Medicare as not medically justified;
O.
Specimen collection, except by venipuncture and capillary or arterial puncture, as a separate service;
P.
Laboratory or X-ray services performed by another facility, which shall be billed to the Program directly by the facility; and
Q.
For certified nurse midwives, a separate visit charge on date of delivery.