Mississippi Administrative Code

Beneficiaries eligible for Medicare and Medicaid must not receive home health visits under both programs simultaneously. Refer to Part 200, Chapter 2, Rule 2.3. A. If Medicare does not cover home health nurse visits, physical therapy visits, or speech therapy visits because skill…

A. The Division of Medicaid covers home health agency reimbursement for covered services based on reasonable cost which is determined in accordance with the Mississippi Medicaid Home Health Reimbursement Plan and Title XVIII (Medicare) principles of reimbursement, except when Med…

Freestanding or hospital-based kidney dialysis centers must satisfy all requirements set forth in Miss. Admin. Code, Part 200, Chapter 4, Rule 4.8, in addition to the following provider type specific requirements: A. National Provider Identifier (NPI), verification from National …

A. The Division of Medicaid covers:1. Hemodialysis, 2. Peritoneal dialysis, 3. Continuous Ambulatory Peritoneal Dialysis (CAPD), and 4. Continuous Cyclic Peritoneal Dialysis (CCPD). B. Prior authorization is not required for dialysis services. C. The Division of Medicaid covers:1…

A. The Division of Medicaid reimburses ESRD facilities the bundled ESRD PPS rate effective as of January 1, of each year. B. The ESRD PPS rate provides a single payment for all resources used in providing dialysis services including supplies, equipment, drugs, biologicals, labora…

A. The Division of Medicaid covers related physician services for ESRD billed with the appropriate procedure codes which are excluded from the ESRD PPS rate. 1. The physician or qualified health care professional must provide one (1) face-to-face visit with the beneficiary monthl…

A. Dialysis providers must maintain auditable records that substantiate the dialysis services provided. B. The physician or qualified healthcare professional's documentation in the medical record must include, but is not limited to, the following: 1. Dates of service, 2. Monthly …

Notes 23 Miss. Code. R. 216-1.6 Miss. Code Ann. § 43-13-121. Revised to correspond with SPA 14-003 (eff. 01/01/2014) eff. 05/01/2014. Reserved 6/1/2025

The Division of Medicaid pays for all medically necessary services for EPSDT-eligible beneficiaries in accordance with Miss. Admin. Code, Part 223 without regard to service limitations and with prior authorization. Notes 23 Miss. Code. R. 216-1.7 Miss. Code Ann. § 43-13-121.

A. Medicaid does not cover contact lenses when prescribed for routine correction of refractive errors. B. Medicaid covers contact lenses prescribed by an ophthalmologist or an optometrist when there is documentation that supports the following criteria: 1. Conventional eyeglasses…

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. 217-2.2 Miss. Code Ann. § 43-13-121

A. Medicaid covers eyeglasses prescribed by an ophthalmologist or optometrist when documentation supports the following:1. Eyeglasses are medically necessary, 2. Eyeglasses are prescribed to significantly improve vision or correct a medical condition, and 3. Eyeglasses meet eyegl…

A. For purposes of this rule the following definitions will apply: 1. Antireflective is a coating applied to a lens to reduce the amount of reflected light and glare that reaches the eye. 2. Mirror coating is applied to a lens that allows the lens to take on the properties of a t…

A. Medicaid covers eyeglasses, including the frames and lenses for beneficiaries who have had surgery on the eyeball or ocular muscle. The surgical benefit will be applied, regardless of whether the beneficiary has received eyeglasses during the benefit period, when all of the fo…

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. 217-3.4 Miss. Code Ann. § 43-13-121

A. State-licensed audiologists and physicians must render services under their license as an audiologist or physician. B. All providers of Medicaid services must comply with the requirements for enrollment as outlined in Part 200, Chapter 4, Rule 4.8. Physicians must satisfy the …

A. Medicaid covers for unilateral cochlear implantation when there is documentation that demonstrates the procedure is medically necessary and would be beneficial in reducing limitations of hearing impairment. B. The following must be documented by the surgeon and/or audiologist:…

A. The Division of Medicaid defines an implantable auditory osseointegrated device (AOD) as a surgically implantable hearing system which transmits sound vibrations through a sound processor to the inner ear by direct bone conduction through the skull. 1. The Division of Medicaid…

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. 218-1.4 Miss. Code Ann. § 43-13-121

Independent laboratory providers must satisfy all requirements set forth in Part 200, Chapter 4, Rule 4.8 in addition to the following provider type specific requirements: A. National Provider Identifier (NPI), verification from National Plan and Provider Enumeration System (NPPE…

A. The Division of Medicaid covers the following tuberculosis (TB) tests when a beneficiary has an increased risk for TB infection, as determined by the Centers for Disease Control and Prevention (CDC) and state law, and is administered in compliance with CDC recommendations and …

The Division of Medicaid does not reimburse independent laboratories for lab procedures performed for beneficiaries during an inpatient hospital stay. The All Patient Refined Diagnosis-Related Group (APR-DRG) payment that the hospital receives is considered to cover all services …

Medicaid covers routine venipuncture performed for the purpose of obtaining a blood sample for laboratory testing as follows: A. Routine venipuncture must be billed with appropriate procedure code. B. Physicians, nurse practitioners, physician assistants, hospitals, and independe…

A. Medicaid only covers Independent Diagnostic Testing Facilities (IDTF), or other independent mobile diagnostic units, including portable x-ray providers, for services provided to dual-eligible beneficiaries. Outpatient testing and diagnostic services are covered when ordered by…

A. The "Trofile Assay" is covered for beneficiaries who are HIV-positive and diagnosed with Acquired Immune Deficiency Syndrome (AIDS) who have evidence of viral replication and HIV-1 strain resistance to multiple anti-retroviral agents. B. Medicaid covers "Trofile Assay" for ben…

A. Medicaid defines paternity testing as any laboratory test used to establish the genetic relationship between an alleged father and a child. B. Medicaid does not cover Paternity testing. Notes 23 Miss. Code. R. 219-1.6 Miss. Code Ann. § 43-13-121

A. Medicaid will cover medically necessary qualitative drug screens for: 1. Suspected drug overdose, and one (1) or more of the following conditions are present: a) Unexplained coma, b) Unexplained altered mental status, c) Severe or unexplained cardiovascular instability, or car…

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. 219-1.8 Miss. Code Ann. § 43-13-121

A. The Division of Medicaid defines genetic testing as a type of analysis that identifies changes in chromosomes, genes, or proteins that confirms or rules out a suspected genetic condition. B. The Division of Medicaid covers genetic testing when medically necessary to establish …

A. Radiology providers must satisfy all requirements set forth in Part 200, Chapter 4, Rule 4.8 in addition to the following provider type specific requirements: 1. National Provider Identifier (NPI), verification from National Plan and Provider Enumeration System (NPPES), 2. Wri…

A. Effective July 1, 2013, nuclear cardiac imaging studies must be prior authorized by the radiology UM/QIO as noted in Rule 1.2. B. The Division of Medicaid covers the following nuclear cardiac imaging: 1. Perfusion of the heart, either at rest or with pharmacological stress, fo…

A. Documentation for advanced imaging procedures must:1. Include the referring physician, nurse practitioner or physician's assistant documentation of medical necessity and criteria met in Rule 1.2, 2. Not duplicate other covered diagnostic tests, 3. Be maintained in the referrin…

A. Effective July 1, 2013, prior authorization is required by the radiology Utilization Management/Quality Improvement Organization (UM/QIO) for medical necessity and appropriateness of the service for the following advanced imaging procedures: 1. Computed Tomography (CT) Scans a…

A. The Division of Medicaid covers radiopharmaceuticals administered for diagnostic or therapeutic purposes separately from the diagnostic procedure or visit. 1. Only the units administered are covered. 2. Radiopharmaceuticals must be approved by the (FDA), used in accordance wit…

Notes 23 Miss. Code. R. 220-1.4 Miss. Code Ann. §§ 43-13-121, 43-13-117(3). Moved with Revisions to Miss. Admin. Code Part 225, Chapter 3 eff. 7/1/2015

A. Medicaid does not cover the review and interpretation of port films, referred to as the professional component. B. Medicaid covers the taking of the port film, one (1) unit for every five (5) treatments, referred to as the technical component. C. Multiple treatments representi…

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. 220-1.6 Miss. Code Ann. § 43-13-121.

A. Effective July 1, 2013, Computed Tomography (CT) scans and Computed Tomography Angiography (CTA), with or without contrast, must be prior authorized by the radiology UM/QIO as noted in Rule 1.2. B. The Division of Medicaid does not cover: 1. A limited or follow-up CT scan for …

A. Effective July 1, 2013, Magnetic Resonance Angiography (MRA) and Magnetic Resonance Imaging MRI), with or without contrast, must be prior authorized by the radiology UM/QIO as noted in Rule 1.2. B. The Division of Medicaid covers a functional MRI when used as part of a preoper…

A. Effective July 1, 2013, Positron Emission Tomography (PET) scans must be prior authorized by the radiology UM/QIO as noted in Rule 1.2. B. The Division of Medicaid covers one (1) fluorodeoxyglucose (FDG) PET scan for solid tumors, myeloma or lymphoma that are biopsy proven or …

The Division of Medicaid covers family planning and family planning related State Plan services and supplies, directly or under arrangements with others, to individuals capable of reproduction, including minors who can be considered to be sexually active, who are eligible under t…

A. Medicaid beneficiaries have the right to freedom of choice of providers for Medicaid covered services in accordance with Miss. Admin. Code Part 200, Rule 3.6. B. Beneficiaries have freedom of choice to: 1. Receive or reject family planning and family planning related services,…

Family planning and family planning related services are exempt from cost sharing (co-pay) requirements in accordance with Miss. Admin. Code Part 200, Rule 3.7. Notes 23 Miss. Code. R. 221-1.3 42 USC § 1396 a; 42 CFR §§447.50 - 447.57; Miss. Code Ann. § 43-13-121. Amended 7/1/201…

A. Family planning and family planning related services are available for eligible beneficiaries who voluntarily choose to: 1. Prevent pregnancy, 2. Plan the number of pregnancies, or 3. Plan the spacing between pregnancies. B. Family planning and family planning related services…

Services and items not considered family planning and family planning related services include, but are not limited to: A. Facilitating services, including, but not limited to, parking and child care while family planning and family planning related services are being obtained, B…

A. Providers of family planning and family planning related services must comply with the requirements for maintenance of records outlined in Miss. Admin. Code Part 200, Rule 1.3. B. Documentation of family planning and family planning related services must include, but are not l…

The Division of Medicaid pays for all medically necessary services for EPSDT-eligible beneficiaries in accordance with Miss. Admin. Code Part 223 without regard to service limitations and with prior authorization. Notes 23 Miss. Code. R. 221-1.7 Miss. Code Ann. § 43-13-121. Amend…