Section 7 AAC 110.405 - Physician services coverage and limitations(a) Subject to 7 AAC 110.400 - 7 AAC 110.455, the department will pay a physician who meets the requirements of 7 AAC 110.400 for the following services provided within the scope of the physician's license to practice medicine or osteopathy: (1) any physician services and supplies necessary for diagnosing and treating illness and injury for which a payment rate has been established by the department that meets the requirements of 7 AAC 145.020;(2) preventive health screening and treatment provided as part of the EPSDT program under 7 AAC 110.200 - 7 AAC 110.215;(3) physician services provided in a nursing facility in accordance with 7 AAC 110.410;(4) sterilization performed by a physician in accordance with 7 AAC 110.415;(5) a hysterectomy performed by a physician in accordance with 7 AAC 110.420;(6) speech-language pathology services, if medically necessary;(7) hearing services, if medically necessary;(8) a complete vision examination, including a check of refractive state, if a complete vision examination is clinically indicated and the recipient has significant difficulties or complaints related to vision;(9) anesthesia, if billed in accordance with the American Society of Anesthesiologists' Relative Value Guide, adopted by reference in 7 AAC 160.900;(10) clinical intervention counseling associated with smoking cessation for no more than 10 sessions per calendar year.(b) The department will pay a physician for vaccine products and administration, in accordance with 7 AAC 110.750. (1) the administration of immunizations to a recipient under 21 years of age;(2) the product and administration of the following vaccines for recipients 19 years of age or older as medically necessary: (C) Herpes Zoster (Shingles);(D) Human Papillomavirus;(E) Measles, Mumps, and Rubella (MMR);(G) Pneumococcal (Polysaccharide);(H) seasonal Influenza, live attenuated nasal spray or inactivated injection;(J) Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis;(K) Varicella (Chickenpox);(3) the administration of the following vaccines for a recipient 19 years of age or older as medically necessary:(A) Influenza A (H1N1) 2009 Monovalent;(c) The department will pay a physician for providing the following services only if those services are provided to a recipient who is under 21 years of age or who is a Medicare recipient:(1) chiropractic manipulation;(d) The department will not pay for the following services provided by a physician: (1) elective surgery that is not medically necessary;(2) infertility services;(3) case management services;(4) plastic or cosmetic services for enhancement purposes;(6) services provided in the operating room on behalf of the physician by a licensed practical nurse, a registered nurse, an intern, or a resident in training used in the operating room;(9) educational services and supplies;(10) interpreter services;(11) experimental or investigative services;(13) programs to improve overall fitness;(14) impotence treatment or services;(15) vaccine products that are available free to the provider;(16) physical examinations, except if (A) given as a screening under the EPSDT program; or(B) the department requests one for the purpose of determining eligibility based upon disability, blindness, or pregnancy: or(C) for recipients 21 years of age and older under 7 AAC 110.800.(17) selected special services and report codes.Eff. 2/1/2010, Register 193; am 6/13/2010, Register 194; am 8/25/2010, Register 195; am 5/1/2016, Register 218, July 2016; am 1/10/2021,Register 237, April 2021; am 7/25/2021, Register 239, October 2021; am 3/3/2023, Register 245, April 2023Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040