Alaska Administrative Code

(a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing physician services, the provider must (1) be enrolled as a physician in accordance with 7 AAC 105.210; and (2) have an active license to practice medicine or osteopathy issued by the jurisdiction in which th…

(a) Subject to 7 AAC 110.400 - 7 AAC 110.455, the department will pay a physician who meets the requirements of 7 AAC 110.400 for the following services provided within the scope of the physician's license to practice medicine or osteopathy: (1) any physician services and supplie…

(a) For a physician visit to a recipient living in a nursing facility, the department will not pay for more than (1) one initial evaluation and management visit per recipient stay; and (2) one subsequent or established care visit per recipient per 30-day period. (b) In addition t…

(a) The department will pay for a sterilization performed by a physician only if (1) the recipient is 21 years of age or older; (2) the procedure is for family planning purposes; (3) the recipient has, by signature, given informed consent using the form provided by the department…

(a) The department will pay for a hysterectomy performed by a physician if the (1) department has given prior authorization; (2) procedure is performed for medical reasons; (3) recipient has given her informed consent in writing using the form provided by the department or a form…

The department will pay for routine obstetrical care provided by a physician. A physician may not submit a claim for routine global obstetrical care if the recipient does not have third-party health insurance available. Notes 7 AAC 110.425 Eff. 2/1/2010, Register 193 Authority:AS…

Office medical supplies routinely associated with physician office visits and procedures are included in the practice cost portion of the resource-based relative value scale (RBRVS) fee schedule developed under 7 AAC 145.050 and are not paid separately. Notes 7 AAC 110.430 Eff. 2…

(a) The department will pay for laboratory services provided by a physician in the physician's own laboratory if the physician holds a CMS Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver under 42 C.F.R. 493.35 - 493.37 or a registration certificate under 4…

(a) The department will pay for diagnostic and follow-up x-rays without prior approval by the department, but films shall be made available to the department on request. (b) The department will not pay for radiologic contrast material separate from coverage for an x-ray except fo…

(a) Subject to the limitations identified in this section, the department will pay for mental health services provided by a physician if those services are (1) medically necessary; (2) rendered directly by that physician; and (3) specified in a treatment plan that meets the requi…

(a) The department will pay for a physician, an advanced practice registered nurse, or a physician assistant acting as a surgical assistant. A second surgical assistant will be paid at the same rate as the first surgical assistant if the primary surgeon submits a written explanat…

(a) For the department to provide payment under 7 AAC 145.200, a physician assistant who furnishes services directly to a recipient in the state must separately enroll with the department as a rendering provider under 7 AAC 105.210 and (1) unless the physician assistant is a fede…

(a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing podiatry services, a provider must (1) be enrolled as a podiatrist in accordance with 7 AAC 105.210; and (2) have an active license to practice podiatry issued by the jurisdiction in which the podiatrist pro…

(a) The department will pay for the podiatry services and supplies identified in the CPT Fee Schedule for Podiatry Servicestable and HCPC Fee Schedule for Podiatry Services table, adopted by reference in 7 AAC 160.900, provided to a Medicaid recipient under 21 years of age who ha…

(a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing private-duty nursing services, a provider must (1) be enrolled as a private-duty nursing agency in accordance with 7 AAC 105.210; and (2) be enrolled as either a hospice service provider under 7 AAC 140.270,…

(a) The department will pay for private-duty nursing services, if they are provided to a recipient who (1) is under 21 years of age; (2) has been recently discharged from a general acute care hospital or long-term care facility, or has a physical health status that would justify …

(a) Private-duty nursing services must be authorized by the department before services are provided. The department will authorize private-duty nursing services for periods up to 60 days, starting on the date the first service is to be provided. (b) To be considered by the depart…

(a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing psychologist testing services, a provider must be an independently practicing psychologist who (1) is enrolled as a psychologist in accordance with 7 AAC 105.210; (2) has an active license to practice psycho…

(a) To be eligible for payment under 7 AAC 105-7 AAC 160, psychologist behavioral health services must be provided by an individual who meets the requirements in 7 AAC 110.550(a)(1) and (2). (b) A provider may only bill the department for the following psychologist behavioral hea…

(a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing clinical social worker services, a provider must (1) be enrolled as a clinical social worker in accordance with 7 AAC 105.210; and (2) have an active license to practice as a clinical social worker issued by…

(a) To be eligible to provide marital and family therapy services for payment under 7 AAC 105 - 7 AAC 160, a provider must (1) be enrolled as a marital and family therapist under 7 A AC 105.210; and (2) have an active license to practice as a marital and family therapist issued b…

(a) To be eligible to provide professional counseling services for payment under 7 AAC 105-7 AAC 160, a provider must (1) be enrolled as a licensed professional counselor under 7 AAC 105.210; and (2) have an active license to practice as a professional counselor issued by the jur…

(a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing targeted case management services, a provider must(1) be enrolled as a provider of those services in accordance with 7 AAC 105.210; (2) be a grantee of the department under AS 47.20 and 7 AAC 23; and (3) pro…

Subject to the requirements of 7 AAC 110.620-7 AAC 110.639, the department will pay for a service delivered by means of a telehealth modality if the service (1) would be covered under 7 AAC 105-7 AAC 160 if delivered in person; and (2) is delivered in compliance with (A) the same…

(a) Subject to the requirements of 7 AAC 110.620 - 7 AAC 110.639, the department will pay for a service delivered by means of one of the following telehealth modalities if the modality and use of the modality meet the requirements of P.L. 104-191(Health Insurance Portability and …

Subject to the requirements of 7 AAC 110.620 - 7 AAC 110.639, to be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing a service by means of a telehealth modality, a provider must meet the following requirements: (1) the provider must have an active license under AS 0…

The department will not pay (1) for the use, or any costs associated with the use, of technological equipment and systems associated with the delivery of a service by means of a telehealth modality; (2) a provider for communication with that provider's supervising provider or com…

In 7 AAC 110.620 - 7 AAC 110.639, (1) "consulting provider" means a provider who evaluates a recipient's healthcare information by means of a telehealth modality based on a referral or request from another provider; (2) "patient-initiated online digital service" means evaluation,…

(a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing vision care services, a provider must (1) be enrolled as a vision care provider in accordance with 7 AAC 105.210; (2) have an active license to practice as an ophthalmologist, an optometrist, or an optician …

(a) The department will pay for only the vision services and products identified in the Fee Schedule for Vision Services, adopted by reference in 7 AAC 160.900, subject to the provisions of this section. (b) The department will pay for the following services in each calendar year…

(a) For a clinically indicated complete vision examination with a check of refractive state, the ophthalmologist or optometrist performing the examination shall (1) record a complete case history, including ocular, physical, occupational, and medical data and other pertinent info…

The department will not pay for (1) aspherical lenses; (2) progressive or no-line multi-focal lenses; (3) vision therapy services for a recipient 21 years of age or older; (4) polarized lenses; (5) anti-reflective or mirror coating; (6) lenses for placement into frames that are n…

(a) To be a covered vaccine product, a vaccine product must be one (1) for which the United States Food and Drug Administration (FDA) requires a national drug code (NDC) number; and (2) that is listed electronically with the FDA. (b) The department will pay for the following vacc…

(a) The department will pay for the following preventive and screening services for a recipient 21 of age or older: (1) an evidence-based item or service with an A or B rating by the United States Preventive Services Task Force (USPSTF) A & B Recommendations for Adults, adopted b…

(a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing outpatient occupational therapy services, a provider must be an (1) occupational therapist who (A) is enrolled in accordance with 7 AAC 105.210; (B) provides documentation of an active license to practice oc…

(a) The department will pay for occupational therapy services and supplies (1) that are identified in the Fee Schedule for Therapy Services, adopted by reference in 7 AAC 160.900; and (2) if those services, except the initial evaluation, are (A) prescribed by a physician, an adva…

(a) Before initiating treatment, the occupational therapist shall conduct an initial evaluation of the recipient that includes an assessment of the (1) recipient's significant past medical history; (2) diagnosis and prognosis, if established, and the extent to which the recipient…

To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing physical therapy, occupational therapy, speech-language pathology services, or an combination of those services, an outpatient therapy center must be (1) enrolled in as an outpatient therapy center provider in a…

(a) The department will pay for only the physical therapy, occupational therapy, and speech-language pathology services and supplies identified in the Fee Schedule for Therapy Services, adopted by reference in 7 AAC 160.900, if those services and supplies, except the initial eval…

(a) Before or at the time of initiating treatment, the outpatient therapy center shall conduct an initial evaluation of the recipient that includes an assessment of the (1) recipient's significant past medical history; (2) diagnosis and prognosis, if established, and the extent t…

(a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing outpatient physical therapy services, the individual must be (1) a physical therapist who (A) is enrolled in accordance with 7 AAC 105.210; (B) provides documentation of an active license to practice physica…

(a) Payment for physical therapy services is limited to (1) evaluations; (2) physical agents; (3) massage and manipulation; (4) therapeutic exercise; (5) hydrotherapy; and (6) other forms of treatment for rehabilitation and restoration of normal bodily functions following acute p…

(a) Before initiating treatment, the physical therapist shall conduct an initial evaluation of the recipient that includes an assessment of the (1) recipient's significant past medical history; (2) diagnosis and prognosis, if established, and the extent to which the recipient is …

(a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing speech-language pathology services, a provider must be (1) a speech-language pathologist who(A) is enrolled in accordance with 7 AAC 105.210; (B) provides documentation of an active license to practice speec…

The department will pay for speech-language pathology services and supplies (1) that are identified in the Fee Schedule for Therapy Senvcis, adopted by reference in 7 AAC 160.900; and (2) if those services and supplies, except the initial evaluation, are (A) prescribed by a physi…

(a) Before initiating treatment, the speech-language pathologist shall conduct an initial evaluation of the recipient that includes an assessment of the (1) recipient's significant past medical history; (2) diagnosis and prognosis, if established, and the extent to which the reci…

(a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing hearing services, the individual must (1) be enrolled in accordance with 7 AAC 105.210; and (2) have an active license to practice as an audiologist or hearing aid dealer issued by the jurisdiction in which …