1. (1) ESWL is a covered benefit for treatment of kidney stones in the renal pelvis, uretero-pelvic junction, and the upper one-third of the ureter.
2. (2) ESWL is not a covered service for urinary stones of the bladder and the lower two-thirds of the ureter.

Author: Charles A. Reasner, Luann C. McQueen

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §§482.11,482.12, 482.22, 482.54.

History: Rule effective October 13, 1987. Amended: Effective December 14, 1990.Emergency rule effective February 4, 1991. Amended: Effective May 14, 1991.