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(a) The division will make payment to a physician in accordance with 7 AAC 43.040, subject to the following exceptions and restrictions:
(1) a physical examination is authorized only for a recipient when given as a screening under the EPSDT program or for a division-requested examination for the purpose of determining eligibility based on disability, blindness, or pregnancy;
(2) immunizations are authorized for recipients under age 21;
(3) payment is not available for nonemergency inpatient hospital services listed in Appendix H of the physician services section of the Alaska Medicaid Provider Billing Manual, revised as of June 1995, unless the services have been authorized by the professional review organization on contract with the division before admission to the hospital; failure to obtain prior authorization will result in nonpayment regardless of the eligibility of the recipient or the appropriateness of the services; the June 1995 revision to Appendix H of the physician services section of the Alaska Medicaid Provider Billing Manual is adopted by reference.
(b) Except as provided in this subsection, the division will not pay for more than one physician visit in a 30-day period for a patient in either a skilled nursing or an intermediate care facility. The division will, in its discretion, pay for additional visits if written justification, acceptable to the division, accompanies the bill for the physician visit.
History: Eff. 8/18/79, Register 71; am 3/25/83, Register 85; am 7/1/85, Register 95; am 9/25/85, Register 95; readopt 8/7/96, Register 139; am 2/1/97, Register 141
Authority: AS 47.05.010
Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.115 in its entirety, without change, under AS 47.05 and AS 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.
The June 1995 revision of Appendix H 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.
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Last modified 7/05/2006