The Program does not cover the following:
A. Services for which the portable X-ray provider cannot provide a properly completed order identifying the authorized ordering physician or practitioner by National Provider Identifier (NPI);
B. Services not adequately documented in the recipientís medical record;
C. Services not medically necessary;
D. Procedures that are known by the provider as investigational or experimental in nature;
E. Services which are specifically included as an integral part of another service;
G. Office visits;
I. Surgeries; and
J. Therapeutic services.
K. X-ray services ordered by an:
(1) Individual who is not enrolled as a provider in the Program with an active status on the date of service; and
(2) Entity, facility, or another provider that is not an individual.