10.09.88.04

.04 Covered Services.

A. The Program covers medically necessary services rendered to recipients, when the services are:

(1) Provided according to the laws and regulations of the State and locality in which they are rendered in accordance with 42 CFR §486.100;

(2) Rendered by a physician who meets the qualification standards in accordance with 42 CFR §486.102 or qualified non-physician (technician) who meets the qualification standards in accordance to 42 CFR §486.104; and

(3) Ordered in writing by the treating physician or nurse practitioner who is enrolled as a provider in the Program with an active status on the date of service in accordance with State law.

B. Portable X-ray services include the following:

(1) Skeletal films involving extremities, pelvis, vertebral column, and skull;

(2) Chest films which do not involve the use of contrast media;

(3) Abdominal films which do not involve the use of contrast media;

(4) Diagnostic mammograms, if approved by the FDA;

(5) Transportation of portable X-ray equipment to a patient’s home or a long term care facility (LTCF); and

(6) Electrocardiograms (EKGs/ECGs).