Section 405IAC5-27-2. Utilization criteria

   Criteria for utilization of radiological services shall include consideration of the following:

(1) Evidence that this radiologic procedure is necessary for the appropriate treatment of illness or injury.

(2) X-rays of the spinal column are limited to cases of acute documented injury or a medical condition where interpretation of x-ray films would make a direct impact on the medical/surgical treatment.

(3) Medicaid reimbursement is available for x-rays of the extremities and spine for the study of neuromusculoskeletal conditions.

(4) Medicaid reimbursement is not available for radiology examinations of any body part taken as a routine study not necessary to the diagnosis or treatment of a medical condition. Situations generally not needing radiologic services include, but are not limited to, the following:

(A) Pregnancy.

(B) Research studies.

(C) Screening.

(D) Routine physical examinations or check-ups.

(E) Premarital examinations.

(F) Fluoroscopy without films.

(Office of the Secretary of Family and Social Services; 405 IAC 5-27-2; filed Jul 25, 1997, 4:00 p.m.: 20 IR 3351; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA)