Authority: IC 12-15-1-10

Affected: IC 12-13-5-1

Sec. 4. If the office of Medicaid policy and planning (office) makes the individual's disability determination, then the office shall pay for the costs of necessary medical examinations and diagnostic tests required to determine whether the applicable visual or disability requirement is met to qualify for Medicaid to the blind or disabled, subject to the following limitations:

1. (1) Payment will be made only to the medical practitioner upon submission of a completed claim form prescribed by the office.
2. (2) Payment for the cost of submitting a report of a previously completed medical examination or other record shall not exceed ten dollars ($10).
3. (3) Payment for an eye examination and completion of a report thereon shall not exceed twenty-nine dollars ($29).
4. (4) Payment for a physical examination or evaluation and completion of a report thereon shall not exceed sixty-five dollars ($65). Examination fees include expenses for basic blood testing and urinalysis. Fees relating to these tests will not be reimbursed separately.
5. (5) Payment for a psychiatric evaluation or testing and completion of a report thereon shall not exceed eighty dollars ($80) per hour.

6. (6) Diagnostic procedures, such as laboratory tests, x-rays, and special testing, may be reimbursed only if authorized in advance of the procedure by the Medicaid medical review team (MMRT) physician. Authorization will only be granted if additional testing is necessary in order to:

   1. (A) confirm the diagnosis or to measure the severity of the impairment; or
   2. (B) assist in completing the examination.
7. Payment will not be made for any treatment given to the applicant.
8. (7) All prior-authorized additional testing, as referenced in subdivision (6), will be reimbursed according to the Medicaid fee-for-service schedule applicable on the date of service.

(Office of the Secretary of Family and Social Services; 405 IAC 2-2-4; filed Nov 1, 1995, 8:30 a.m.: 19 IR 351; 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; filed Apr 8, 2014, 12:37 p.m.: 20140507-IR-405130533FRA; readopted filed Nov 13, 2019, 11:54 a.m.: 20191211-IR-405190487RFA; readopted filed Oct 8, 2025, 3:16 p.m.: 20251105-IR-405240502RFA)