Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 26 - COVERED SERVICES
Section 26-5 - Services Not Covered

Universal Citation: WY Code of Rules 26-5

Current through September 21, 2024

(a) The Wyoming Department of Health shall not cover the following services and supplies:

(i) Except in an emergency, services furnished without the consent of the client or the client's legal guardian;

(ii) Experimental procedures which are not generally accepted or used by a provider's peer group as current or standard practice;

(iii) Examinations or reports required for legal purposes or other purposes not specifically related to medical care;

(iv) Services furnished outside the United States;

(v) Services furnished to an individual who is an inmate of a public institution, or an individual that is in the custody of a state, local, or federal law enforcement agency;

(vi) Services provided to an individual during the first seventy-two (72) hours of emergency detention;

(vii) Services provided to clients age 22 - 64 in an IMD, including Medicare secondary claims;

(viii) Unless pre-approved, services which exceed the service limitations;

(ix) Services provided pursuant to a court order if such services:
(A) Are not covered services;

(B) Exceed service limitations;

(C) Are furnished by a health care practitioner or facility that is not a provider on the date(s) of services;

(D) Have not received prior authorization, if applicable; or

(E) Have not received admission certification, if applicable.

(x) Abortions, except to the extent required by 42 C.F.R. § 441.200§ 441.208;

(xi) Acupuncture;

(xii) Alcohol and chemical rehabilitation furnished to an inpatient, except for purposes of detoxification or stabilization of acute conditions;

(xiii) Autopsies;

(xiv) Biofeedback therapies and equipment;

(xv) Chronic pain rehabilitation;

(xvi) Community mental health services furnished outside Wyoming;

(xvii) Cosmetic procedures;

(xviii) Custodial care including but not limited to non-skilled, personal care. Personal care would include help with activities of daily living, such as bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom;

(xix) Infertility services, includes but is not limited to counseling, reverse sterilization and artificial insemination;

(xx) Missed or canceled appointments;

(xxi) Personal comfort items;

(xxii) Private-duty nursing services;

(xxiii) Sterilizations, unless the requirements of 42 C.F.R. § 441.250§ 441.259 are satisfied; and

(xxiv) Gender reassignment surgery.

Disclaimer: These regulations may not be the most recent version. Wyoming 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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