<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.09.02.04" title_num="10" subtitle_num="09" chapter_num="02" heading="Covered Services.">
  <text>The Program covers the following medically necessary services rendered to participants:</text>
  <paragraph num="A.">
    <text>Physicians’ services rendered in the physician’s office, the participant’s home, a hospital, a skilled or intermediate care nursing facility, a freestanding clinic, or elsewhere when these services are:</text>
    <paragraph num="(1)">
      <text>Performed by the physician or one of the following:</text>
      <paragraph num="(a)">
        <text>Another licensed physician either in the physician's employ or one who renders services through a reciprocal agreement as a substitute physician,</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A certified registered physician's assistant, licensed registered nurse, certified psychologist, or a certified social worker, provided that the individual performing the service is in the physician's employ and is under the physician's direct supervision and performs the service within the scope of the individual's license or certification for the purpose of assisting in the provision of physicians' services,</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A certified nurse midwife who performs medically necessary services within the provider's scope of practice as described in COMAR 10.27.05; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A certified nurse practitioner who performs medically necessary services within the provider's scope of practice as described in COMAR 10.27.07.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Clearly related to the participant’s individual medical needs as diagnostic, curative, palliative, or rehabilitative services;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Adequately described in the participant’s medical record;</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Consultations;</text>
  </paragraph>
  <paragraph num="C.">
    <text>Diagnostic procedures to include:</text>
    <paragraph num="(1)">
      <text>Procedures related to the patient's medical needs;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Laboratory services performed by a physician or personnel under the physician's direct supervision, when the physician is not required to register his office as a medical laboratory pursuant to Health-General Article, Title 17, Subtitle 2, Annotated Code of Maryland;</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Drugs dispensed by the physician within the limitations of COMAR 10.09.03;</text>
  </paragraph>
  <paragraph num="E.">
    <text>Injectable drugs administered by the provider within the limitations of COMAR 10.09.03;</text>
  </paragraph>
  <paragraph num="F.">
    <text>Medical equipment and supplies dispensed by the physician within the limitations of COMAR 10.09.12;</text>
  </paragraph>
  <paragraph num="G.">
    <text>Abortions performed in accordance with the Health-General Article, Title 20, Subtitles 1 and 2, Annotated Code of Maryland;</text>
  </paragraph>
  <paragraph num="H.">
    <text>Sterilizations when performed according to criteria contained in 42 Code of Federal Regulations §§441.250—441.258 and when the appropriate forms, as established by guideline, are properly completed and attached to the claim;</text>
  </paragraph>
  <paragraph num="I.">
    <text>Vaccine administrations when the vaccines:</text>
    <paragraph num="(1)">
      <text>Meet the following conditions for coverage under the Vaccines for Children Program:</text>
      <paragraph num="(a)">
        <text>Covered under the Vaccines for Children program;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Administered to participants eligible for the Vaccines for Children program; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Administered by providers eligible to be reimbursed for vaccine administration under the Vaccines for Children program; or</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Are supplied to providers by the federal government at no charge, including but not limited to the administration of COVID-19 vaccinations.</text>
    </paragraph>
  </paragraph>
</regulation>