1. (1) All physician services rendered to each outpatient maintenance dialysis patient (regardless of the patient's mode of or setting for dialysis) shall be billed on a monthly capitation basis.

2. (2) Services not covered by the monthly capitation payment (MCP) and which are reimbursed in accordance with usual and customary charge rules are limited to: Medicaid

   1. (a) Declotting of shunts
   2. (b) Covered physician services furnished to hospital inpatients by a physician who elects not to receive the MCP for these services.
   3. (c) Nonrenal related physician services. These services may be furnished either by the physician providing renal care or by another physician. They may not be incidental to services furnished during a dialysis session, or office visit necessitated by the renal condition.

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §405.542(c), and Federal Register (July 2, 1986).

History: Rule effective October 1, 1982. Amended: Effective January 12, 1987.