Statutes, codes, and regulations
Wyoming Administrative Code
Agency 048 - Health, Department ofSubagency 0037 - Medicaid
Chapter 26 - COVERED SERVICES
Section 26-5 - Services Not Covered

048-26 Wyo. Code R. § 26-5

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Current through April 27, 2019
Section 26-5 - Services Not Covered

The following services and supplies specified in this Section are not covered by the Department:

(a) Except in an emergency, services furnished without the consent of the client or the client's legal guardian;

(b) Experimental procedures which are not generally accepted or used by a provider's peer group as current or standard practice;

(c) Examinations or reports required for legal purposes or other purposes not specifically related to medical care;

(d) Services furnished outside the United States;

(e) Services furnished to an individual who is an inmate of a Public Institution, or an individual that is in the custody of a state, local, or federal law enforcement agency;

(f) Services provided to an individual during the first seventy-two (72) hours of emergency detention;

(g) Services provided to clients age 22 - 64 in an IMD, including Medicare secondary claims (cross over claims);

(h) Unless pre-approved, services which exceed the service limitations (cap limits) established by the rules of the Department;

(i) Services provided pursuant to a court order if such services:

  • (i) Are not covered services;
  • (ii) Exceed service limitations;
  • (iii) Are furnished by a health care practitioner or facility that is not a provider on the date(s) of services;
  • (iv) Have not received prior authorization, if applicable; or
  • (v) Have not received admission certification, if applicable.

(j) Abortions, except to the extent required by 42 C.F.R. § 441.200- 441.208;

(k) Acupuncture;

(l) Alcohol and chemical rehabilitation furnished to an inpatient, except for purposes of detoxification or stabilization of acute conditions;

(m) Autopsies;

(n) Biofeedback therapies and equipment;

(o) Chronic pain rehabilitation;

(p) Community mental health services furnished outside Wyoming;

(q) Cosmetic procedures, except as specified in Section 25 of this Chapter;

(r) Custodial care such as non-skilled, personal care. Personal care would include help with activities of daily living, such as bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom;

(s) Infertility services, including counseling, reverse sterilization and artificial insemination;

(t) Missed or canceled appointments;

(u) Personal comfort items;

(v) Private-duty nursing services;

(w) Sterilizations, unless the requirements of 42 C.F.R. §441.250- 441.259 are satisfied; and

(x) Gender reassignment surgery.

048-26 Wyo. Code R. § 26-5

Amended, Eff. 12/17/2015.

Amended, Eff. 4/9/2019.