405 IAC 5-16-6 - Freestanding clinics and surgical centers; limitations
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 6.
Medicaid reimbursement is available to freestanding clinics and surgical centers for services provided to members subject to the following limitations:
(1) Prior authorization
is required for all services and supplies the charges for which exceed the cost
limits or utilization parameters set out in this article.
(2) Medicaid reimbursement is not available
for facility charges if the services provided are such that they ordinarily
could have been provided in a physician's office. Such services provided
outside a physician's office will be reimbursed at the fee allowed for the same
service provided in the office.
Notes
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