Section 17b-262-612 - Services not coveredThe department shall not pay for the following:
(a) Any procedures or services of an unproven, educational, social, research, experimental or cosmetic nature; for any diagnostic, therapeutic or treatment procedures in excess of those deemed medically necessary by the department to treat the client's condition; or for services not directly related tothe client's diagnosis, symptoms or medical history;(b) Any examinations, laboratory tests, biological products, immunizations or other products which are furnished free of charge;(c) Information or services provided to a client by a provider over the telephone;(d) An office visit for the sole purpose of the client obtaining a prescription where the need for the prescription has already been determined;(e) Cancelled office visits and appointments not kept;(g) Services provided in an acute care hospital if the department determines the admission does not, or retrospectively did not, fit the department's utilization review requirements pursuant to section 17-134d-80 of the Regulations of Connecticut State Agencies;(h) Services provided by the admitting provider in an acute care hospital shall not be made or costs for such services may be recouped if it is determined by the department's utilization review, either prospectively or retrospectively, that the admission did not fulfill the accepted professional criteria for medical necessity, appropriateness of setting or quality of care;(i) A laboratory charge for laboratory services performed by a laboratory outside of the nurse practitioner's office. The laboratory shall bill the department for services rendered when a nurse practitioner refers a client to a private laboratory; and(j) The following routine laboratory tests which shall be included in the fee for an office visit and shall not be billed on the same date of service: urinalysis without microscopy,hemoglobin determination and urine glucose.Conn. Agencies Regs. § 17b-262-612
Effective August 10, 1998; Amended April 2, 2015