La. Admin. Code tit. 50 § XXIII-305

Current through Register Vol. 50, No. 11, November 20, 2024

Section XXIII-305 - Excluded Services

A. Services excluded from coverage are:

1. any service that is not authorized by the interdisciplinary team, even if it is a required service, unless it is an emergency service;

2. private room and private duty nursing services in an inpatient facility (unless medically necessary), and nonmedical items for personal convenience such as telephone charges and radio or television rental (unless specifically authorized by the interdisciplinary team as part of the participant's plan of care);

3. cosmetic surgery, which does not include surgery that is required for improved functioning of a malformed part of the body resulting from an accidental injury or for reconstruction following mastectomy;

4. experimental medical, surgical or other health procedures;

5. services furnished outside of the United States except as follows:

a. in accordance with 42 CFR 424.122 - 424.124; or

b. as permitted under the state's approved Medicaid plan.

La. Admin. Code tit. 50, § XXIII-305

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 30:246 (February 2004), Amended by the Department of Health, Bureau of Health Services Financing and the Office of Aging and Adult Services, LR 50400 (3/1/2024).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254, Title XIX of the Social Security Act, and 42 CFR 460 et seq.