Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.09 - Medical Laboratories
Section 10.09.09.06 - Preauthorization Requirements
Universal Citation: MD Code Reg 10.09.09.06
Current through Register Vol. 51, No. 19, September 20, 2024
A. Preauthorization is required for any service identified as needing preauthorization in the current laboratory fee schedule, in accordance with Regulation .07D of this chapter.
B. The provider shall submit the request for preauthorization according to the procedures established by, and in the form designated by, the Department.
C. Preauthorization is issued when:
(1) Program procedures are met;
and
(2) The provider submits to the
Department adequate documentation demonstrating that the service to be
preauthorized is medically necessary.
D. Preauthorization is valid for services rendered or initiated within 90 days of the date issued.
E. Preauthorization for Services Billed to Medicare.
(1) If Medicare covers and approves
a service for which preauthorization by the Program is normally required, the
Program shall waive preauthorization requirements for that service.
(2) If Medicare rejects the entire claim or
any part of a claim for a service that normally requires preauthorization, and
the claim is referred to the Program for payment, the Program shall pay only
for the Medicare-rejected covered services if authorization for those services
was obtained prior to the date of service.
Disclaimer: These regulations may not be the most recent version. Maryland 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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
