<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.09.02.06" title_num="10" subtitle_num="09" chapter_num="02" heading="Preauthorization Requirements.">
  <paragraph num="A.">
    <text>The following procedures or services require preauthorization:</text>
    <paragraph num="(1)">
      <text>Cosmetic surgery;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Contact lens evaluation and fitting;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Lipectomy and panniculectomy;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Transplantations of vital organs;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Services rendered to an inpatient before one preoperative day;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Surgical procedures for the treatment of obesity;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Surgical procedures for the purpose of gender reassignment; and</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Elective services from a noncontiguous state.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Services which have been determined by Medicare to be ineffective, unsafe, or without proven clinical value are generally presumed to be not medically necessary, but will be preauthorized if the provider can satisfactorily document medical necessity in a particular case. These services are found in the Medicare Carriers Manual, Part 3, Claims Process, Chapter II, Coverage Issues Appendix.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Physicians dispensing or prescribing eyeglasses shall comply with the requirements of COMAR 10.09.14.</text>
  </paragraph>
  <paragraph num="D.">
    <text>The Department will preauthorize services when the provider submits to the Department adequate documentation demonstrating that the service to be preauthorized is medically necessary.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Preauthorization normally required by the Program is waived when the service is covered and approved by Medicare. Non-Medicare claims require preauthorization according to §§A—D of this regulation.</text>
  </paragraph>
  <paragraph num="F.">
    <text>Physicians rendering mental health services shall comply with the preauthorization requirements of COMAR 10.09.70.07.</text>
  </paragraph>
</regulation>