The Program does not cover the following:

1. A. Services not specified in Regulation .04 of this chapter;
2. B. Services not medically necessary;
3. C. Investigational and experimental drugs and procedures;
4. D. Services denied by Medicare as not medically justified;
5. E. Separate billing of services which are included in the composite Medicare rate for an ambulatory surgical center;

6. F. Surgical procedures which:

   1. (1) Generally result in extensive blood loss;
   2. (2) Require major or prolonged invasion of body cavities;
   3. (3) Directly involve major blood vessels;
   4. (4) Are generally emergency or life-threatening in nature;
   5. (5) Commonly require systemic thrombolytic therapy;
   6. (6) Are designated as requiring inpatient care (overnight);
   7. (7) Can only be reported using a CPT unlisted surgical procedure code; or
   8. (8) Are otherwise excluded under 42 CFR §411.15(a)—(h) and (j)—(s);
7. G. Physicians' services, including surgical procedures and all preoperative and postoperative services performed by a physician;
8. H. Anesthesia services;
9. I. Radiology services other than those integral to performance of a covered surgical procedure;
10. J. Diagnostic procedures other than those directly related to a covered surgical procedure;
11. K. Ambulance services;
12. L. Leg, arm, back, and neck braces other than those that serve the function of a cast or splint;
13. M. Artificial limbs; or
14. N. Non-implantable prosthetic devices and durable medical equipment (DME).

Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

Effective date: September 2, 1991 (18:17 Md. R. 1918)

Regulation .01B amended effective September 29, 2003 (30:19 Md. R. 1332); April 5, 2010 (37:7 Md. R. 571); March 16, 2015 (42:5 Md. R. 485)

Regulation .02B amended effective March 16, 2015 (42:5 Md. R. 485)

Regulation .02C amended as an emergency provision effective September 16, 1992 (19:20 Md. R. 1812); amended permanently effective January 1, 1993 (19:25 Md. R. 2205)

Regulation .03 amended effective March 16, 2015 (42:5 Md. R. 485)

Regulation .03B amended effective April 5, 2010 (37:7 Md. R. 571)

Regulation .04C amended effective September 29, 2003 (30:19 Md. R. 1332); April 5, 2010 (37:7 Md. R. 571); March 16, 2015 (42:5 Md. R. 485)

Regulation .04D adopted effective March 16, 2015 (42:5 Md. R. 485)

Regulation .05 amended effective April 5, 2010 (37:7 Md. R. 571)

Regulation .05F amended effective March 16, 2015 (42:5 Md. R. 485)

Regulation .06 amended effective April 5, 2010 (37:7 Md. R. 571); March 16, 2015 (42:5 Md. R. 485)

Regulation .06B amended effective April 12, 2004 (31:7 Md. R. 584)

Regulation .06H amended effective July 4, 2016 (43:13 Md. R. 712)