Md. Code Regs. 10.14.04.06

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.14.04.06 - Covered Services

A. The following breast cancer services are covered for enrollees under this chapter through the Breast and Cervical Cancer Program:

(1) Annual clinical breast examinations;

(2) Mammograms that are provided:

(a) Annually to enrollees 50 years old or older; and

(b) At least on a biennial basis to enrollees 40 years old through 49 years old; and

(3) Follow-up clinical breast examinations, mammograms, ultrasounds, and surgical consults as considered medically necessary by the participating medical provider under the Breast and Cervical Cancer Program.

B. The following breast cancer services are covered for enrollees under this chapter through the Reimbursement for Breast and Cervical Cancer Diagnosis and Treatment Program:

(1) A physician's services as described in COMAR 10.14.02.04C ;

(2) A nurse practitioner's services as described in COMAR 10.14.02.05C ;

(3) A nurse anesthetist's services as described in COMAR 10.14.02.06C ;

(4) A physical therapist's services as described in COMAR 10.14.02.07B ;

(5) A pharmacy's services as described in COMAR 10.14.02.08B ;

(6) A hospital's services as described in COMAR 10.14.02.09B ;

(7) A medical supply company's services as described in COMAR 10.14.02.10B ;

(8) A home health service provider's services as described in COMAR 10.14.02.11B ;

(9) A medical laboratory's services as described in COMAR 10.14.02.12B ; or

(10) A free-standing ambulatory surgical center's services as described in COMAR 10.14.02.13B.

C. The following breast cancer services are not covered for enrollees under this chapter:

(1) A physician's services as described in COMAR 10.14.02.04D ;

(2) A nurse practitioner's services as described in COMAR 10.14.02.05D ;

(3) A nurse anesthetist's services as described in COMAR 10.14.02.06D ;

(4) A physical therapist's services as described in COMAR 10.14.02.07C ;

(5) A pharmacy's services as described in COMAR 10.14.02.08C ;

(6) A hospital's services as described in COMAR 10.14.02.09C ;

(7) A medical supply company's services as described in COMAR 10.14.02.10C ;

(8) A home health service provider's services as described in COMAR 10.14.02.11D ;

(9) A medical laboratory's services as described in COMAR 10.14.02.12C ; or

(10) A free-standing ambulatory surgical center's services as described in COMAR 10.14.02.13C.

Md. Code Regs. 10.14.04.06