<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.09.42.05" title_num="10" subtitle_num="09" chapter_num="42" 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>Services denied by Medicare as not medically justified;</text>
  </paragraph>
  <paragraph num="E.">
    <text>Separate billing of services which are included in the composite Medicare rate for an ambulatory surgical center;</text>
  </paragraph>
  <paragraph num="F.">
    <text>Surgical procedures which:</text>
    <paragraph num="(1)">
      <text>Generally result in extensive blood loss;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Require major or prolonged invasion of body cavities;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Directly involve major blood vessels;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Are generally emergency or life-threatening in nature;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Commonly require systemic thrombolytic therapy;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Are designated as requiring inpatient care (overnight);</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Can only be reported using a CPT unlisted surgical procedure code; or</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Are otherwise excluded under 42 CFR §411.15(a)—(h) and (j)—(s);</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Physicians' services, including surgical procedures and all preoperative and postoperative services performed by a physician;</text>
  </paragraph>
  <paragraph num="H.">
    <text>Anesthesia services;</text>
  </paragraph>
  <paragraph num="I.">
    <text>Radiology services other than those integral to performance of a covered surgical procedure;</text>
  </paragraph>
  <paragraph num="J.">
    <text>Diagnostic procedures other than those directly related to a covered surgical procedure;</text>
  </paragraph>
  <paragraph num="K.">
    <text>Ambulance services;</text>
  </paragraph>
  <paragraph num="L.">
    <text>Leg, arm, back, and neck braces other than those that serve the function of a cast or splint;</text>
  </paragraph>
  <paragraph num="M.">
    <text>Artificial limbs; or</text>
  </paragraph>
  <paragraph num="N.">
    <text>Non-implantable prosthetic devices and durable medical equipment (DME).</text>
  </paragraph>
</regulation>