Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-531 - Physician-related services › Section 182-531-0150 - Noncovered physician-related and health care professional services-General and administrative

Current through Register Vol. 24-14, July 15, 2024
(1) The
				medicaid agency evaluates a request for noncovered services in this chapter
				under WAC
				182-501-0160. In addition to
				noncovered services found in WAC
				182-501-0070, except as provided
				in subsection (2) of this section, the agency does not cover:
(a) Acupuncture, massage, or massage
				therapy;
(b) Any service
				specifically excluded by statute;
(c) Care, testing, or treatment of
				infertility or sexual dysfunction. This includes procedures for donor ovum,
				donor sperm, gestational carrier, and reversal of vasectomy or tubal
				ligation;
(d) Hysterectomy
				performed solely for the purpose of sterilization;
(e) Cosmetic treatment or surgery, except as
				provided in WAC
				182-531-0100
				(4)(x);
(f) Experimental or investigational services,
				procedures, treatments, devices, drugs, or application of associated services,
				except when the individual factors of an individual client's condition justify
				a determination of medical necessity under WAC
				182-501-0165;
(g) Hair transplantation;
(h) Marital counseling or sex
				therapy;
(i) More costly services
				when the medicaid agency determines that less costly, equally effective
				services are available;
(j)
				Vision-related services as follows:
(i)
				Services for cosmetic purposes only;
(ii) Group vision screening for eyeglasses;
				and
(iii) Refractive surgery of any
				type that changes the eye's refractive error. The intent of the refractive
				surgery procedure is to reduce or eliminate the need for eyeglass or contact
				lens correction. This refractive surgery does not include intraocular lens
				implantation following cataract surgery;
(k) Payment for body parts, including organs,
				tissues, bones and blood, except as allowed in WAC
				182-531-1750;
(l) Physician-supplied medication, except
				those drugs which the client cannot self-administer and therefore are
				administered by the physician in the physician's office;
(m) Physical examinations or routine
				checkups, except as provided in WAC
				182-531-0100;
(n) Foot care, unless the client meets
				criteria and conditions outlined in WAC
				182-531-1300, as follows:
(i) Routine foot care including, but not
				limited to:
(A) Treatment of tinea
				pedis;
(B) Cutting or removing
				warts, corns and calluses; and
(C)
				Trimming, cutting, clipping, or debriding of nails.
(ii) Nonroutine foot care including, but not
				limited to, treatment of:
(A) Flat
				feet;
(B) High arches (cavus
				foot);
(C) Onychomycosis;
(D) Bunions and tailor's bunion (hallux
				valgus);
(E) Hallux
				malleus;
(F) Equinus deformity of
				foot, acquired;
(G) Cavovarus
				deformity, acquired;
(H) Adult
				acquired flatfoot (metatarsus adductus or pes planus);
(I) Hallux limitus.
(iii) Any other service performed in the
				absence of localized illness, injury, or symptoms involving the foot;
(o) Except as provided in WAC
				182-531-1600, weight reduction
				and control services, procedures, treatments, devices, drugs, products, gym
				memberships, equipment for the purpose of weight reduction, or the application
				of associated services;
(p)
				Nonmedical equipment;
(q)
				Nonemergent admissions and associated services to out-of-state hospitals or
				noncontracted hospitals in contract areas; and
(r) Early elective deliveries as defined in
				WAC 182-500-0030.