Division of Medicaid

A. Rural Emergency Hospitals (REH) services include all covered outpatient department services when furnished by a REH and including but not limited to: 1. Emergency department services, 2. Laboratory services, 3. Diagnostic radiologic services, 4. Behavioral health services, and…

Inpatient Services are not covered in Rural Emergency Hospitals (REH), except for post-hospital extended care services that are furnished in a distinct unit licensed as a skilled nursing facility (SNF). Notes 23 Miss. Code. R. 202-6.4 42 C.F.R. §§ 440.20, 447.201, 447.203. Adopte…

A. Rural Emergency Hospitals (REH) are reimbursed for certain procedure codes the appropriate Outpatient Prospective Payment System (OPPS) rate, plus five percent (5%). B. REH are not eligible for Disproportionate Share Hospital (DSH) payments. Notes 23 Miss. Code. R. 202-6.5 42 …

Physician providers may participate in the Medicaid program upon compliance with provider enrollment requirements outlined in Part 200, Chapter 4, Rule 4.8 in addition to the specific provider type requirements listed below. Physicians, osteopaths, chiropractors and podiatrists m…

The Division of Medicaid pays for all medically necessary services for EPSDT-eligible beneficiaries in accordance with Part 223 of Title 23, without regard to service limitations and with prior authorization. Notes 23 Miss. Code. R. 203-1.10 Miss. Code Ann. § 43-13-121

A. The Division of Medicaid defines a Global Package as a single payment for necessary services and products normally furnished during the pre-operative, intra-operative and postoperative periods by the "same physician" which is defined as physicians and/or other qualified health…

Effective for dates of services on and after July 1, 2022, physicians' services are reimbursed at ninety percent (90%) of the Medicare Physician Fee Schedule. Notes 23 Miss. Code. R. 203-1.2 Miss. Code Ann. §§ 43-13-117, 43-13-121. Amended 7/1/2021 Amended 7/1/2022

Medicaid does not provide separate reimbursement for most Evaluation and Management (E&M) services when a substantial diagnostic or therapeutic procedure is performed. Notes 23 Miss. Code. R. 203-1.3 Miss. Code Ann. § 43-13-121

A. The Division of Medicaid covers a combined total of sixteen (16) non-psychiatric physician office and hospital outpatient department visits per state fiscal year whether occurring during or after office hours or provider established office hours. [Refer to Miss. Admin. Code, P…

A. An initial hospital visit for the beneficiary's attending physician is covered. A subsequent hospital visit is not covered on the same day as the initial visit. B. Following the date of admission, only one subsequent hospital visit per day is allowed to the attending physician…

A. Locum Tenens: For purposes of this rule a "locum tenens" arrangement is defined when the regular physician retains a substitute physician to take over the practice during an absence. A regular physician is the physician that is normally scheduled to see a patient. The regular …

A. Medicaid does not apply Medicare policy related to billing for services performed by residents in a teaching facility. Medicaid does not cover services provided under the direction of the teaching physician. B. Medicaid covers teaching physicians, who are supervising residents…

A. Physicians, physician assistants, or nurse practitioners must bill the appropriate procedure evaluation and management code, fracture or dislocation codes, or application of casts and strapping code to be reimbursed professional fees for application of casts, splints, or strap…

A. Medicaid covers the removal of impacted cerumen only for symptoms directly related to the presence of impacted cerumen. Symptoms include, but are not limited to, the following: 1. Earache, 2. Itching of the ear, 3. Feeling that the ear is plugged, 4. Partial hearing loss, 5. R…

A. The Division of Medicaid defines skin and soft tissue substitutes as types of wound coverage materials composed of human tissue, non-human tissue, synthetic materials, or a composite of these materials which mimic or substitute for some aspect of the skin's structure, either p…

A. The Division of Medicaid covers medically necessary physician-administered drugs and implantable drug system devices defined as a drug other than vaccines, diagnostic or therapeutic radio pharmaceutical, contrast imaging agent, biological or implantable drug system device cove…

A. In accordance with federal regulations, the Division of Medicaid collects Medicaid drug rebates from manufacturers on physician-administered drugs per the following: 1. Effective for all drugs administered on and after January 1, 2008, providers must submit the National Drug C…

Refer to Miss. Admin. Code Part 203, Rule 2.1 Notes 23 Miss. Code. R. 203-2.3 Miss. Code Ann. § 43-13-121. Revised and added Miss. Admin. Code Part 203, Rule 2.3.A, B.15, B.16. and deleted Rule 2.3.B.7. eff. 07/01/2014. Transferred 5/1/2016

Refer to Miss. Admin. Code Part 203, Rule 2.1 Notes 23 Miss. Code. R. 203-2.4 Miss. Code Ann. § 43-13-121 Transferred 5/1/2016

Refer to Miss. Admin. Code Part 203, Rule 2.1 Notes 23 Miss. Code. R. 203-2.5 Miss. Code Ann. § 43-13-121 Transferred 5/1/2016

Refer to Miss. Admin. Code Part 203, Rule 2.1 Notes 23 Miss. Code. R. 203-2.6 42 CFR §§435.116, 440.210; Miss. Code Ann. § 43-13-121. Amended 9/1/2015 Transferred 5/1/2016

The Division of Medicaid pays for all medically necessary services for EPSDT-eligible beneficiaries in accordance with Part 223 of Title 23, without regard to service limitations and with prior authorization. Notes 23 Miss. Code. R. 203-2.7 Miss. Code Ann. § 43-13-121

A. Providers of anesthesia services must comply with all requirements set forth in Part 200, Chapter 4, Rule 4.8 for all providers in addition to the specific provider type requirement below: 1. Obtain National Provider Identifier (NPI) with verification from National Plan and Pr…

A. Medicaid covers anesthesia services provided by an anesthesiologist/certified registered nurse anesthetists (CRNA). B. Medicaid covers CRNAs for anesthesia services for surgical procedures using the appropriate anesthesia codes. C. Medicaid covers administration of anesthesia …

A. Medicaid covers an anesthesiologist who assumes full responsibility for a patient while the anesthesia is being administered by a resident in a teaching facility. 1. Medicaid only covers one anesthesiologist for the professional services. 2. Medicaid covers the appropriate mod…

A. Medicaid defines one (1) anesthesia time unit as one (1) minute. B. Medicaid defines anesthesia time as when the anesthesiologist begins to prepare the patient for anesthesia care in the operating room or in an equivalent area, and ends when the anesthesiologist is no longer i…

The Division of Medicaid pays for all medically necessary services for EPSDT-eligible beneficiaries in accordance with Part 223 of Title 23, without regard to service limitations and with prior authorization. Notes 23 Miss. Code. R. 203-3.5 Miss. Code Ann. § 43-13-121

A. For purposes of this chapter Medicaid defines the following terms related to surgery as follows: 1. Add-on codes are procedures performed in addition to the primary service/procedure and are never reported as a stand-alone code.a) Add-on codes describe additional intra-service…

A. Medicaid covers abdominal panniculectomy (abdominoplasty, abdominodermatolipectomy) only when there is medical documentation that demonstrates the procedure is: 1. Medically necessary, 2. Reconstructive, 3. Performed to alleviate the patient's symptomatology, and 4. Performed …

A. Medicaid covers a surgical blepharoplasty when performed by a general surgeon, plastic surgeon or ophthalmologist in the physician's office, inpatient or outpatient facility or an ambulatory surgical center. B. Medicaid defines: 1. Blepharoplasty as any surgery of the eyelid p…

A. Medicaid does not cover circumcisions unless medical necessity is documented in the medical record according to the criteria listed below.1. A diagnosis which justifies the medical necessity for circumcision including, but not limited to, recurrent balanoposthitis or recurrent…

Refer to Miss. Admin. Code Part 203, Rule 2.1 Notes 23 Miss. Code. R. 203-4.13 Miss. Code Ann. § 43-13-121 Transferred 5/1/2016

Refer to Miss. Admin. Code Part 203, Rule 2.1 Notes 23 Miss. Code. R. 203-4.14 Miss. Code Ann. § 43-13-121 Transferred 5/1/2016

A. Medicaid covers the initial evaluation consultation to diagnose the condition and/or develop a plan of treatment. B. Medicaid covers treatment only when there is medical documentation that demonstrates any of the following signs and symptoms:1. Pain, 2. Persistent itching and/…

A. Medicaid covers mastectomy, including reconstruction if necessary, for gynecomastia when considered medically necessary when the following criteria are met: 1. The tissue removed is glandular breast tissue and not the result of obesity, adolescence, or reversible effects of a …

A. Medicaid covers otoplasty for the correction of ears that protrude more than twenty (20) millimeters (mm) and at an angle greater than thirty five (35) degrees from the occipital scalp when the following criteria is meet:1. For the correction of an external ear deformity assoc…

A. The Division of Medicaid covers reduction mammoplasty only when there is medical documentation that demonstrates the procedure is: 1. Medically necessary, 2. Reconstructive, and 3. Performed as a last means of attempting to alleviate a beneficiary's symptomatology and dysfunct…

A. Medicaid does not cover removal of benign skin tags that do not pose a threat to health or function. B. Medicaid covers the removal of skin tags when there is medical documentation that one or more of the following conditions exist:1. The skin tag has one or more of the follow…

A. Medicaid covers an assistant surgeon during major surgery, including all surgical cases performed under spinal or regional anesthesia if the nature of the surgery requires the assistance of a second physician or surgeon. Medicaid covers only one (1) assistant surgeon for any c…

Medicaid covers uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea syndrome if all of the following are present: A. Documented obstructed sleep apnea (OSA) with apnea hypopnea index (AHI) or respiratory disturbance index (RDI) which meets the following paramet…

A. Medicaid covers medically necessary procedures for the insertion or removal of FDA-approved ventricular assist devices (VAD) in accordance with its FDA approved uses as follows:1. Post-cardiotomy procedures for insertion/removal of a VAD performed during the period following o…

The Division of Medicaid pays for all medically necessary services for EPSDT-eligible beneficiaries in accordance with Part 223 of Title 23, without regard to service limitations and with prior authorization. Notes 23 Miss. Code. R. 203-4.22 Miss. Code Ann. § 43-13-121

A. The Division of Medicaid covers Gastric Electrical Stimulation (GES) when used for the treatment of chronic intractable (drug-refractory) nausea and vomiting secondary to gastroparesis of diabetic or idiopathic etiology. The Food and Drug Administration has approved the GES de…

A. Medicaid covers the individual skills of two (2) or more surgeons when required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and/or the patient's condition. In these cases, the …

A. Medicaid covers two (2) or more surgeons to perform surgery on the same patient during the same operative session. B. Medicaid covers the surgeons of different specialties performing a different procedure, even if the procedures are performed through the same incision. C. The …

A. Part 203, Chapter 4 Rule 4.5.A, B is applicable for assistant surgeon, team surgeon, or cosurgeon services. B. Medicaid reimburses for the primary procedure at the highest reimbursement rate from the Medicaid Physician Fee Schedule. The primary surgical procedure must be bille…

A. Medicaid covers bilateral procedures performed during an operative setting, when reported with the appropriate procedure code and modifier. One (1) procedure will be paid at one hundred percent (100%) of the Medicaid allowable and the second procedure will be paid at fifty per…