1. (a) Payment is made for the use of a treatment room associated with outpatient observation services. Observation services must be ordered by a physician or other individual authorized by state law. Observation services are furnished by the hospital on the hospital's premises and include use of the bed and periodic monitoring by hospital staff. Observation services must include a minimum of eight (8) hours of continuous care. Outpatient observation services are not covered when they are provided:

   1. (1) On the same day as an emergency department visit.
   2. (2) Prior to an inpatient admission, as those observation services are considered part of the inpatient DRG.
   3. (3) For the convenience of the member, member's family or provider.
   4. (4) When specific diagnoses are not present on the claim.
   5. (5) As part of another service, i.e. for post operative monitoring; recovery after diagnostic testing or concurrently with therapeutic services such as chemotherapy.
2. (b) Payment is made for observation services in a labor or delivery room. Observation services must include a minimum of eight (8) hours of continuous care. Specific pregnancy-related diagnoses are required.

Added at 24 Ok Reg 317, eff 12-1-06 (emergency)

Added at 24 Ok Reg 905, eff 5-11-07

Amended at 27 Ok Reg 110, eff 10-2-09 (emergency)

Amended at 27 Ok Reg 948, eff 5-13-10

Amended at 37 Ok Reg 100, eff 10-2-19 (emergency)

Amended at 37 Ok Reg 1511, eff 9-14-20