1. (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. (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. (2) preventive health screening and treatment provided as part of the EPSDT program under 7 AAC 110.200 - 7 AAC 110.215;
   3. (3) physician services provided in a nursing facility in accordance with 7 AAC 110.410;
   4. (4) sterilization performed by a physician in accordance with 7 AAC 110.415;
   5. (5) a hysterectomy performed by a physician in accordance with 7 AAC 110.420;
   6. (6) speech-language pathology services, if medically necessary;
   7. (7) hearing services, if medically necessary;
   8. (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. (9) anesthesia, if billed in accordance with the American Society of Anesthesiologists' Relative Value Guide, adopted by reference in 7 AAC 160.900;
   10. (10) clinical intervention counseling associated with smoking cessation for no more than 10 sessions per calendar year.
2. (b) The department will pay a physician for vaccine products and administration, in accordance with 7 AAC 110.750.

3. (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. (1) chiropractic manipulation;
   2. (2) podiatry services.

4. (d) The department will not pay for the following services provided by a physician:

   1. (1) elective surgery that is not medically necessary;
   2. (2) infertility services;
   3. (3) case management services;
   4. (4) plastic or cosmetic services for enhancement purposes;
   5. (5) repealed 7/25/2021;
   6. (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. (7) medical testimony;
   8. (8) travel services;
   9. (9) educational services and supplies;
   10. (10) interpreter services;
   11. (11) experimental or investigative services;
   12. (12) swimming therapy;
   13. (13) programs to improve overall fitness;
   14. (14) impotence treatment or services;
   15. (15) vaccine products that are available free to the provider;

   16. (16) physical examinations, except if

       1. (A) given as a screening under the EPSDT program;
       2. (B) the department requests one for the purpose of determining eligibility based upon disability, blindness, or pregnancy; or
       3. (C) for recipients 21 years of age and older under 7 AAC 110.800;
   17. (17) selected special services and report codes.

(Eff. 2/1/2010, Register 193; am 6/13/2010, Register 194; am 8/25/2010, Register 195; am 5/1/2016, Register 218; am 1/10/2021, Register 237; am 7/25/2021, Register 239; am 3/3/2023, Register 245)

Authority: AS 47.05.010, AS 47.07.030, AS 47.07.040