Md. Code Regs. 10.09.55.05

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.55.05 - Limitations

The Program does not cover the following under these regulations:

A. Services not encompassed by the physician assistant's written delegation agreement with the physician, if required by the state in which services are provided;

B. Services not medically necessary;

C. Services prohibited by the Board;

D. Services prohibited in the state in which services are provided;

E. Physician assistant services included as part of the cost of an inpatient facility, hospital outpatient department, or freestanding clinic;

F. Visits by or to the physician assistant solely for the purpose of the following:

(1) Prescription, drug, or food supplement pickup;

(2) Recording of an electrocardiogram;

(3) Ascertaining the patient's weight;

(4) Interpretation of laboratory tests or panels; or

(5) Prescribing or administering oral medications;

G. Drugs and supplies which are acquired by the licensed and certified physician assistant at no cost;

H. Injections and visits solely for the administration of injections, unless medical necessity and the patient's inability to take appropriate oral medications are documented in the patient's medical record;

I. More than one visit per day per participant unless adequately documented as an emergency situation;

J. Services paid under the free-standing dialysis program described in COMAR 10.09.22;

K. Physician assistant billings for those laboratory or X-ray services performed by another facility, which shall bill the Program directly;

L. Immunizations required for travel outside the continental United States;

M. Acupuncture;

N. Hypnosis;

O. Travel expenses;

P. Prescriptions and injections for central nervous system stimulants and anoretic agents when used for weight control;

Q. Investigational or experimental drugs and procedures;

R. Services denied by Medicare as not medically justified; and

S. Services for which the patient specifically requests to see a physician.

Md. Code Regs. 10.09.55.05

Regulations .05 effective April 2, 2001 (28:06 Md. R. 620)
Regulations .05 repealed effective April 28, 2014 (41:8 Md. R. 471)
Regulations .05 adopted effective 42:9 Md. R. 647, eff.5/11/2015