Mississippi Administrative Code

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…

A. The applicable modifiers for bilateral procedures, multiple procedures, co-surgeons, surgical teams, and assistant surgeons must be utilized on claims for surgery. B. Medicaid reimburses for surgical care only at eighty-five percent (85%) of the Medicaid allowable. The applica…

A. Medicaid considers the following incidental and not covered: 1. A diagnostic scope and a surgical scope in the same setting, 2. A diagnostic scope with biopsy and a surgical scope, 3. A diagnostic scope with or without biopsy done with an endoscope and an open surgical procedu…

A. The surgeon is responsible for daily post-operative pain management services except under extraordinary circumstances. B. Medicaid covers post-operative pain management provided by several means, including, but not limited to:1. Oral and parenteral administration, 2. Patient c…

A. Medicaid covers chiropractic services for manual manipulation of the spine to correct a subluxation. B. An x-ray must demonstrate that a subluxation exists and if the subluxation has resulted in a neuromusculoskeletal condition for which manipulation is appropriate treatment. …

The fee for chiropractic manipulation shall be reimbursed per the fee schedule and shall not exceed seven hundred dollars ($700) per fiscal year (July 1 - June 30) per beneficiary. Notes 23 Miss. Code. R. 203-5.2 Miss. Code Ann. § 43-13-121

A. A chiropractor must use the appropriate procedure code for manual manipulation of the spine to correct subluxation. Medicaid coverage will be provided for one (1) procedure code that encompasses the entire treatment for any given day. B. Necessity of treatment must be document…

A. For beneficiaries covered under Medicare and Mississippi Medicaid (dual eligibles), chiropractic providers must not file a claim with Medicaid for the manipulation of the spine procedures not covered by Medicare. Mississippi Medicaid benefits are not available for services tha…

The chiropractor must maintain auditable records that substantiate the services provided. At a minimum, the records must contain the following on each patient: A. The dates of services provided. B. The patient's presenting complaint. C. Date of the x-ray which must be within twel…

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. 203-5.6 Miss. Code Ann. § 43-13-121

Medicaid covers the following podiatry services: A. Laboratory services required for care of a systemic condition are covered only to the MD/DO supervising the systemic condition or to a laboratory to which the MD/DO has referred the specimen. B. Physical therapy services that ar…

Medicaid does not cover the following: A. Identification of culture of fungi in the toenail clippings is not covered. A. Local anesthesia, digital blocks, or topical anesthesia done with a specific surgical procedure. C. Cast applications/strapping/splinting charged separately fr…

A. Medicaid does not cover local infiltration, metacarpal/ metatarsal/ digital blocks, or topical anesthesia outside the specific surgical procedure performed. B. Medicaid covers the cost of drugs used for IV sedation and must be billed with the appropriate HCPCS code Notes 23 Mi…

Medicaid requires podiatry providers to maintain auditable records that will substantiate the services provided. At a minimum, the records must contain the following on each patient: A. Date(s) of service, B. Patient's presenting complaint(s), C. Patient's history and physical fi…

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. 203-6.5 Miss. Code Ann. § 43-13-121

A. Advanced Practice Registered Nurses (APRNs), also referred to as Nurse Practitioners (NPs), certified by the state in which they practice may participate in the Mississippi Medicaid Program upon compliance with provider enrollment requirements outlined in Part 200, Chapter 4, …

A. The Division of Medicaid covers services provided by Advanced Practice Registered Nurses (APRNs), also referred to as Nurse Practitioners (NPs), certified by the state in which they practice, for services rendered within the scope of practice allowed by their protocol. B. NPs …

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. 203-7.3 Miss. Code Ann. § 43-13-121

A. Physician assistants (PAs), who are licensed by the Mississippi State Board of Medical Licensure, and are practicing with physician supervision under regulations adopted by the board, may participate in the Mississippi Medicaid Program upon compliance with provider enrollment …

A. Physician assistants (PAs) may bill the Division of Medicaid for the covered services within the scope of practice allowed by their protocol. B. PAs must bill the appropriate Current Procedure Terminology (CPT) code for services rendered and follow the same rules and guideline…

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. 203-8.3 Miss. Code Ann. § 43-13-121

Psychiatric services described in this chapter must be provided by a licensed physician (medical doctor or doctor of osteopathy) who is board-certified in psychiatry or by a licensed Psychiatric Mental Health Nurse Practitioner (PMHNP). Rules included in this chapter do not apply…

A. All services must be personally and directly provided by the psychiatrist or PMHNP who requests reimbursement for the service. B. Services must be based on beneficiary need and not the convenience of the beneficiary, the beneficiary's family or the provider. C. A provider may …

The following psychiatric services are eligible for reimbursement by Medicaid only when they have been personally and directly provided by a licensed physician (medical doctor or doctor of osteopathy) who is board-certified in psychiatry or by a licensed Psychiatric Mental Health…

A. Services are not eligible for reimbursement unless they are personally and directly provided by the servicing provider. B. Educational interventions of an academic nature are not eligible for Medicaid reimbursement. C. Medicaid will not reimburse more than once for the same se…

A. The Division of Medicaid defines service limits as the maximum quantity of services per beneficiary that are eligible for reimbursement by the Division of Medicaid within a given time frame, either daily or yearly. B. Daily service limits apply to beneficiaries, regardless of …

A. Physicians are required to maintain auditable records that will verify any or all services provided and billed under the Medicaid program.1. Records must, be made available to representatives of the Division of Medicaid or Office of the Attorney General in substantiation of cl…

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. 203-9.7 Miss. Code Ann. § 43-13-121

The Division of Medicaid is authorized to furnish: A. Dental care that is an adjunct to treatment of an acute medical or surgical condition, B. Services of oral surgeons and dentists in connection with surgery related to the jaw or any structure contiguous to the jaw or the reduc…

Notes 23 Miss. Code. R. 204-1.10 Removed eff. 05/01/2014.

A. The Division of Medicaid covers medically necessary dental treatment in the outpatient hospital or Ambulatory Surgical Center (ASC) setting when all the following are met: 1. Quality, safe, and effective treatment cannot be provided in an office setting, 2. Inpatient hospitali…

The Division of Medicaid defines a limited oral evaluation as an evaluation or re-evaluation limited to a specific oral health problem. A. The Division of Medicaid covers limited oral evaluations four (4) times per state fiscal year. B. This may require interpretation of informat…

The Division of Medicaid covers consultation services for dentists or dental specialists. A. The Division of Medicaid does not cover the visit or exam on the same day as the initial consultation by the consulting dentist or dental specialist. B. The Division of Medicaid covers di…

A. The Division of Medicaid defines a topical anesthetic as an agent used to temporarily anesthetize or numb the tiny nerve endings located on the surfaces of the oral mucosa. The Division of Medicaid does not cover the cost of the topical anesthetic and the application of the to…

A. The Division of Medicaid defines a bone replacement graft as a procedure which involves the use of osseous autografts, osseous allografts, or non-osseous grafts to stimulate bone formation or periodontal regeneration when the disease process has led to a deformity of the bone.…

Dental providers must maintain auditable records containing documentation that substantiate the services provided in accordance with requirements set forth in Miss. Admin. Code Part 200, Chapter 1, Rule 1.3. including, but not limited to: A. Date of service, B. History taken on i…

The Division of Medicaid pays for all medically necessary services for Early and Periodic Screening, Diagnosis and Treatment (EPSDT)-eligible beneficiaries in accordance with Miss. Admin. Code Part 223, without regard to service limitations and with prior authorization. A. Orthod…

A. The Division of Medicaid reimburses dental providers based on a statewide uniform fee schedule. B. Dental providers must bill the procedure code that accurately reflects the services rendered as follows: 1. Dental procedures performed by a Mississippi licensed dentist must be …

A. Dentists must comply with all requirements set forth in Miss. Admin. Code Part 200, Chapter 4, Rule 4.8 for all providers in addition to the provider specific requirements below: 1. National Provider Identifier (NPI), verification from National Plan and Provider Enumeration Sy…

A. Covered dental services include:1. Limited oral evaluation, problem-focused, 2. Radiographs, 3. Gingivectomy and/or gingivoplasty for Dilantin therapy only, 4. Oral surgery, 5. Extractions, and 6. Alveoloplasty. Notes 23 Miss. Code. R. 204-1.3 Miss. Code Ann. § 43-13-121.…

A. Non-covered dental services include, but not limited to, the following: 1. Comprehensive oral evaluation, 2. Preventive services, 3. Amalgams, composites, and crowns, 4. Endodontics, 5. Dentures, and 6. Orthodontia. B. The Division of Medicaid does not cover for scheduling/res…

A. The Division of Medicaid covers dental expenditures, excluding orthodontia-related services, up to twenty five hundred dollars ($2,500.00) per beneficiary per state fiscal year. B. All American Dental Association (ADA) dental procedure codes, except orthodontia-related service…

A. The Division of Medicaid requires prior authorization, except for emergencies, from the Utilization Management/Quality Improvement Organization (UM/QIO) of the following dental services:1. Surgical access of an unerupted tooth, 2. Radical resection of mandible with tooth bone …

The Division of Medicaid covers lab and pathology services if the provider performs the service in their office and must have a Clinical Laboratory Improvement Amendment (CLIA) certificate number on file with Medicaid. Notes 23 Miss. Code. R. 204-1.7 Miss. Code Ann. §§ 43-13-171,…