Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 110 - Medicaid Coverage; Professional Services
Article 10 - Physician Services
7 AAC 110.405 - Physician services coverage and limitations
Universal Citation: 7 AK Admin Code 110.405
Current through November 28, 2024
(a) Subject to 7 AAC 110.400 - 7 AAC 110.455, the department will pay a physician who meets the requirements of 7 AAC 110.400 for the following services provided within the scope of the physician's license to practice medicine or osteopathy:
(1) any physician services and supplies
necessary for diagnosing and treating illness and injury for which a payment
rate has been established by the department that meets the requirements of
7
AAC 145.020;
(2) preventive health screening and treatment
provided as part of the EPSDT program under
7
AAC 110.200 - 7 AAC 110.215;
(3) physician services provided in a nursing
facility in accordance with
7
AAC 110.410;
(4) sterilization performed by a physician in
accordance with
7
AAC 110.415;
(5) a hysterectomy performed by a physician
in accordance with
7
AAC 110.420;
(6) speech-language pathology services, if
medically necessary;
(7) hearing
services, if medically necessary;
(8) a complete vision examination, including
a check of refractive state, if a complete vision examination is clinically
indicated and the recipient has significant difficulties or complaints related
to vision;
(9) anesthesia, if
billed in accordance with the American Society of Anesthesiologists'
Relative Value Guide, adopted by reference in
7
AAC 160.900;
(10) clinical intervention counseling
associated with smoking cessation for no more than 10 sessions per calendar
year.
(b) The department will pay a physician for vaccine products and administration, in accordance with 7 AAC 110.750.
(1) the administration of immunizations to a
recipient under 21 years of age;
(2) the product and administration of the
following vaccines for recipients 19 years of age or older as medically
necessary:
(A) Hepatitis A;
(B) Hepatitis B;
(C) Herpes Zoster (Shingles);
(D) Human Papillomavirus;
(E) Measles, Mumps, and Rubella
(MMR);
(F) Meningococcal;
(G) Pneumococcal (Polysaccharide);
(H) seasonal Influenza, live attenuated nasal
spray or inactivated injection;
(I)
Tetanus Diphtheria;
(J) Tetanus
Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis;
(K) Varicella (Chickenpox);
(3) the administration of the
following vaccines for a recipient 19 years of age or older as medically
necessary:
(A) Influenza A (H1N1) 2009
Monovalent;
(B) Rabies.
(c) The department will pay a physician for providing the following services only if those services are provided to a recipient who is under 21 years of age or who is a Medicare recipient:
(1) chiropractic
manipulation;
(2) podiatry
services.
(d) The department will not pay for the following services provided by a physician:
(1) elective surgery that is not medically
necessary;
(2) infertility
services;
(3) case management
services;
(4) plastic or cosmetic
services for enhancement purposes;
(5) repealed 7/25/2021;
(6) services provided in the operating room
on behalf of the physician by a licensed practical nurse, a registered nurse,
an intern, or a resident in training used in the operating room;
(7) medical testimony;
(8) travel services;
(9) educational services and
supplies;
(10) interpreter
services;
(11) experimental or
investigative services;
(12)
swimming therapy;
(13) programs to
improve overall fitness;
(14)
impotence treatment or services;
(15) vaccine products that are available free
to the provider;
(16) physical
examinations, except if
(A) given as a
screening under the EPSDT program; or
(B) the department requests one for the
purpose of determining eligibility based upon disability, blindness, or
pregnancy: or
(C) for recipients 21
years of age and older under
7
AAC 110.800.
(17) selected special services and report
codes.
Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040
Disclaimer: These regulations may not be the most recent version. Alaska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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