Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 106. Physician services

7 AAC 43.106. Physician services

(a) The division will enroll as a Medicaid provider a physician who is practicing individually or with a group and who is authorized to practice under AS 08.64.

(b) To be reimbursed for dispensing prescribed drugs, a licensed physician must separately enroll as a dispensing physician pharmacy provider and bill the division in accordance with 7 AAC 43.590. Prescribed drugs dispensed by a physician will be reimbursed in accordance with 7 AAC 43.591.

(c) The division will reimburse an in-state physician in accordance with 7 AAC 43.040.

(d) The division will reimburse an enrolled physician for the services of a physician collaborator in accordance with this subsection. The physician collaborator must be employed by, in a contractual relationship with, or under the supervision of the physician. The services must be billed to the division in accordance with 7 AAC 43.040, except that the division will pay 85 percent of the rate identified in the fee schedule established under 7 AAC 43.108. To bill the division for services of a physician collaborator, the enrolled physician need not be on the premises when services are provided, but the physician must assume professional responsibility for the services and assure that the services are medically appropriate. The physician shall indicate on the claim form the services provided by a physician collaborator by adding the appropriate modifier after the applicable procedure codes.

(e) Office medical supplies and services associated with office visits and procedures are included in the practice cost portion of the fee schedule and may not be separately reimbursed. Non-routine supplies will be reimbursed at the lesser of billed charges or the amounts listed in Table I-6 of the physician services section of the Alaska Medicaid Provider Billing Manual, dated February 1998. The February 1998 revision of Table I-6 of the physician services section of the Alaska Medicaid Provider Billing Manual is adopted by reference.

(f) Repealed 12/2/2005.

History: Eff. 2/1/97, Register 141; am 6/26/98, Register 146; am 12/2/2005, Register 176

Authority: AS 47.05.010

AS 47.07.030

AS 47.07.040

Editor's note: Table I-6 of the physician services section of the Alaska Medicaid Provider Billing Manual may be obtained by contacting the Department of Health and Social Services, Division of Medical Assistance, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.