Regulation .15 Medical Management Fee.
Regulation .15 Medical Management Fee.LinkCopy Citation
A.
A participating health care provider eligible to receive a medical management fee may be one of the following:
(1)
Anesthesiologist;
(2)
Certified nurse midwife;
(3)
Family practitioner;
(4)
Gynecologist;
(5)
Medical internist;
(6)
Medical oncologist;
(7)
Nurse anesthetist;
(8)
Nurse practitioner;
(9)
Pathologist;
(10)
Physician assistant;
(11)
Radiation oncologist;
(12)
Radiologist;
(13)
Surgeon; and
(14)
Participating health care provider who renders services pursuant to §B of this regulation.
B.
The Department shall reimburse a participating health care provider as outlined in §A of this regulation a medical management fee of $50 each time a reimbursed service:
(1)
Is in compliance with the medical guidelines pursuant to Regulation .04A(7)(a)—(f) of this chapter;
(2)
Involves a consult with an oncologist pursuant to Regulation .04A(7)(g) and (h) of this chapter;
(3)
Is in compliance with the medical care management guidelines pursuant to Regulation .04A(6) of this chapter; or
(4)
Is billed with the medical management fee for reporting and includes a copy of the relevant medical report including, but not limited to:
(a)
Radiology;
(b)
Biopsy;
(c)
Operative; or
(d)
Staging.
C.
The Program shall reimburse for claims pursuant to this regulation as set forth in Regulation .21 of this chapter.