Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 9 - HOSPITAL SERVICES
Section 9-10 - Outpatient hospital services
Universal Citation: WY Code of Rules 9-10
Current through September 21, 2024
(a) Covered services. Subject to the service limitations of Section 11, outpatient hospital services are covered services if provided:
(i) Pursuant to the written orders of a
physician;
(ii) By or under the
supervision of a physician and
(iii) Subject to subsection (b).
(b) Limited and excluded services.
(i) The limitations and exclusions specified
in Sections 11 and 12;
(ii) Cardiac
rehabilitation programs are covered if provided in the outpatient department of
a hospital, and:
(A) The recipient has:
(I) Documented diagnosis, in medical records,
of acute myocardial infarction within the preceding twelve months;
(II) Had coronary bypass surgery;
or
(III) Stable angina pectoris;
and
(B) The recipients
condition requires direct, continuing supervision by a physician.
(iii) Diabetic education programs
are covered if:
(A) The recipient is newly
diagnosed as diabetic; or
(B) The
recipient is an unstable diabetic who is newly insulin dependent.
(iv) Itinerant physician clinic
services are covered if the clinic is conducted by a physician who has a
contractual agreement with the hospital.
(v) Except as otherwise specified in this
Chapter, physical, occupational or speech therapy services are covered if
prescribed by the attending physician and recertified by the attending
physician every thirty days, and:
(A)
Prescribed as part of the plan of treatment during an inpatient hospital stay
and such therapy continues on an outpatient basis until the plan of treatment
is concluded;
(B) Prescribed as a
direct result of outpatient surgery or injury; or
(C) Prescribed and provided to prevent
inpatient hospitalization.
(vi) Psychiatric services are covered if:
(A) The recipient is evaluated by a multi-
disciplinary treatment team of mental health professionals; and
(B) Provided pursuant to an individualized
treatment plan.
(vii)
Any other services limited or excluded by Chapter 26.
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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