Section 17b-262-645 - Services covered and limitations(a) The department shall pay for the following:(1) medically appropriate and medically necessary clinical laboratory services, for which the laboratory holds certification according to the provisions of CLIA, which are listed in the department's fee schedule; and(2) for HealthTrack and HealthTrack Special Services.(b) Limitations on covered services shall be as follows: (1) payment shall not be made for laboratory fees to the physician, nurse-midwife, nurse practitioner, or referring laboratories for services performed in a separate private laboratory;(2) when laboratory services are performed in a private laboratory, billing for the service shall be made by the laboratory. Payment shall not be made to the referring physician, nurse-midwife, nurse practitioner, or to another laboratory which has referred the specimen to the performing laboratory for testing;(3) payment shall not be made for testing and analysis which is available free of charge; and(4) payment shall not be made for any procedures or services of an unproven, educational, social, research, experimental, or cosmetic nature; for services in excess of those deemed medically necessary and medically appropriate to treat the client's condition; or for services not directly related to the client's diagnosis, symptoms, or medical history.Conn. Agencies Regs. § 17b-262-645
Adopted effective May 10, 2000