<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.09.08.06" title_num="10" subtitle_num="09" chapter_num="08" heading="Limitations.">
  <text>The Program does not cover the following:</text>
  <paragraph num="A.">
    <text>Services not specified in Regulation .04 of this chapter;</text>
  </paragraph>
  <paragraph num="B.">
    <text>Services not medically necessary;</text>
  </paragraph>
  <paragraph num="C.">
    <text>Investigational and experimental drugs and procedures;</text>
  </paragraph>
  <paragraph num="D.">
    <text>Procedures solely for cosmetic purposes;</text>
  </paragraph>
  <paragraph num="E.">
    <text>Services denied by Medicare as not medically justified;</text>
  </paragraph>
  <paragraph num="F.">
    <text>Freestanding clinic services for inpatient  participants in State-operated facilities serving individuals with intellectual disabilities;</text>
  </paragraph>
  <paragraph num="G.">
    <text>Freestanding clinic services provided to hospital inpatients;</text>
  </paragraph>
  <paragraph num="H.">
    <text>Freestanding clinic visits when patients are referred to hospital outpatient departments or emergency rooms for services ordinarily provided in freestanding clinics covered by this chapter;</text>
  </paragraph>
  <paragraph num="I.">
    <text>Freestanding clinic visits solely for the purpose of one or more of the following:</text>
    <paragraph num="(1)">
      <text>Prescription drugs or collection of laboratory specimens, unless otherwise allowed;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Certification or recertification of food supplements;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Performing laboratory tests required only for certification or recertification of food supplement programs;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Nutritional assessments in the absence of diagnosis of nutritional disorders, unless EPSDT or primary health services are provided at the same time;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Ascertaining the patient's weight;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Interpretation of laboratory tests or panels; and</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Measurement of blood pressure;</text>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>Office visits solely for the administration of injectable medications, unless medical necessity and the patient’s inability to take appropriate oral medications are documented in the medical record;</text>
  </paragraph>
  <paragraph num="K.">
    <text>More than one visit per day to the same freestanding clinic, unless the additional visit is adequately documented as:</text>
    <paragraph num="(1)">
      <text>An emergency situation; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A visit to a different specialty;</text>
    </paragraph>
  </paragraph>
  <paragraph num="L.">
    <text>Central nervous system stimulants and anorectic agents when used for weight control;</text>
  </paragraph>
  <paragraph num="M.">
    <text>Immunizations required solely for travel outside the continental United States;</text>
  </paragraph>
  <paragraph num="N.">
    <text>Vision care services excluded under COMAR 10.09.14 or COMAR 10.09.23;</text>
  </paragraph>
  <paragraph num="O.">
    <text>Separate billing for services which are specifically included as part of another service;</text>
  </paragraph>
  <paragraph num="P.">
    <text>Separate reimbursement to a practitioner for services provided in a freestanding clinic in addition to the freestanding clinic reimbursement;</text>
  </paragraph>
  <paragraph num="Q.">
    <text>Payment for more than one visit to complete an EPSDT screening service;</text>
  </paragraph>
  <paragraph num="R.">
    <text>Visits solely for group or individual health education;</text>
  </paragraph>
  <paragraph num="S.">
    <text>Freestanding clinic visits in addition to an EKG procedure when the EKG procedure is the only purpose for the visit; and</text>
  </paragraph>
  <paragraph num="T.">
    <text>Services for which preauthorization is required under Regulation .09 of this chapter but has not been obtained.</text>
  </paragraph>
</regulation>