993.1 Interprofessional consultation occurs when a beneficiary's treating practitioner (physician or other qualified health provider) requests the opinion and/or treatment advice of a consulting practitioner (physician or other qualified health provider with specific specialty expertise) to assist the treating practitioner with the beneficiary's care without face-to-face contact between the beneficiary and the consulting practitioner.

993.2 Interprofessional Consultation must be for the direct benefit of the beneficiary, and directly relevant to the beneficiary's diagnosis and treatment. The consulting practitioner must have specialized expertise in the treatment of the particular health concerns experienced by the beneficiary.

993.3 The consulting practitioner shall submit the claim for interprofessional consultation and provide documentation that the consultation was for the direct benefit of the beneficiary.

993.4 Both the treating practitioner and consulting practitioner must be enrolled as a Medicaid provider, pursuant to Chapter 94 of Title 29 DCMR.

993.5 Interprofessional consultation shall be reimbursed pursuant to Subsection 995.1 of this Chapter.

SOURCE: Final Rulemaking published at 51 DCR 1678 (February 13, 2004); as amended by Final Rulemaking published at 54 DCR 6435 (June 29, 2007); as amended by Final Rulemaking published at 55 DCR 10154 (October 3, 2008); as amended by Final Rulemaking published at 61 DCR 2621 (March 28, 2014); as amended by Final Rulemaking published at 72 DCR 010225 (September 19, 2025).