Regulation .05 Limitations.
Regulation .05 Limitations.LinkCopy Citation
The Program does not cover the following:
A.
Services for which the portable X-ray provider cannot provide a properly completed order identifying the authorized ordering physician or practitioner by National Provider Identifier (NPI);
B.
Services not adequately documented in the recipient’s medical record;
C.
Services not medically necessary;
D.
Procedures that are known by the provider as investigational or experimental in nature;
E.
Services which are specifically included as an integral part of another service;
F.
Consultations;
G.
Office visits;
H.
Injections;
I.
Surgeries; and
J.
Therapeutic services.
K.
X-ray services ordered by an:
(1)
Individual who is not enrolled as a provider in the Program with an active status on the date of service; and
(2)
Entity, facility, or another provider that is not an individual.