10.09.88.05

.05 Limitations.

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;

F. Consultations;

G. Office visits;

H. Injections;

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.