subchapter 25P – medical-surgical

section .0100 – Reserved for future codification

10a ncac 25p .0100       reserved for future codification

section .0200 – inpatient hospital services

10A NCAC 25P .0201       INPATIENT HOSPITAL SERVICES

History Note:        Authority G.S. 108A‑25(b); S.L. 1985, c. 479, s. 86; 42 C.F.R. 440.230(d); 42 C.F.R.447.253; 42 C.F.R. 456.1;

Eff. February 1, 1976;

Readopted Eff. October 31, 1977;

Amended Eff. October 1, 1986; August 1, 1986; October 1, 1982;

Temporary Amendment Eff. October 15, 1999;

Temporary Amendment Expired July 28, 2000;

Temporary Amendment Eff. September 25, 2000;

Temporary Amendment Expired June 29, 2001;

Transferred from 10A NCAC 22O .0401(e) Eff. May 1, 2012;

Repealed Eff. June 1, 2019.

section .0300 – outpatient hospital services

10A NCAC 25P .0301       OUTPATIENT HOSPITAL SERVICES

History Note:        Authority G.S. 108A‑25(b); 42 C.F.R. 440.20; 42 C.F.R. 440.230(d); 42 C.F.R. 456.1;

Eff. February 1, 1976;

Readopted Eff. October 31, 1977;

Amended Eff. October 1, 1986;

Transferred from 10A NCAC 22O .0402 Eff. May 1, 2012;

Repealed Eff. June 1, 2019.

section .0400 – other services

10A NCAC 25P .0401       PHYSICIAN SERVICES

History Note:        Authority G.S. 108A‑25(b); 108A‑54; 108A‑55; 42 C.F.R. 440.50; 42 C.F.R. 440.230(d); 42 C.F.R. 456.1;

Eff. February 1, 1976;

Readopted Eff. October 31, 1977;

Amended Eff. October 1, 1986; January 1, 1986;

Transferred from 10A NCAC 22O .0404 Eff. May 1, 2012;

Expired Eff. August 1, 2016 pursuant to G.S. 150B-21.3A.

10A NCAC 25P .0402       CLINIC SERVICES

History Note:        Authority G.S. 108A‑25(b); 108A‑54; 42 C.F.R. 440.20;

Eff. February 1, 1976;

Amended Eff. September 30, 1977;

Readopted Eff. October 31, 1977;

Amended Eff. January 1, 1984;

Recodified from 10 NCAC 26B .0113 Eff. October 1, 1993;

Recodified from 10 NCAC 26B .0114 Eff. January 1, 1998;

Transferred from 10A NCAC 22O .0115 Eff. May 1, 2012;

Repealed Eff. June 1, 2019.

10A NCAC 25P .0403       CHIROPRACTIC SERVICES

10A NCAC 25P .0404       PODIATRIST SERVICES

History Note:        Authority G.S. 108A‑25(b); 108A‑54; S.L. 1985, c. 479, s. 86; 42 C.F.R. 440.60; 42 C.F.R. 440.230(d)

Eff. February 1, 1976;

Amended Eff. September 30, 1977;

Readopted Eff. October 31, 1977;

Amended Eff. January 1, 2009; May 1, 1990; January 1, 1984;

Transferred from 10A NCAC 22O .0106, .0405 Eff. May 1, 2012;

Expired Eff. August 1, 2016 pursuant to G.S. 150B-21.3A.

10A NCAC 25P .0403       CHIROPRACTIC SERVICES

(a)  No reimbursement from North Carolina Medicaid shall be made for x‑rays or other diagnostic or therapeutic services provided by a chiropractor except as provided in this Rule.

(b)  Medicaid coverage of chiropractic services is limited to manual manipulation of the spine to correct a subluxation.

(c)  Subluxation shall be confirmed by physical examination or by one set of x-rays taken within six months of the initial date of service.

(d)  The treatment plan shall document:

(1)           the symptoms or diagnosis treated;

(2)           diagnostic procedures and treatment modalities used;

(3)           results of diagnostic procedures and treatments; and

(4)           anticipated length of treatments.

(e)  Medical documentation shall support continued treatment.

(f)  Chiropractic providers shall meet the educational requirements as outlined in 42 CFR 410.21(a).

History Note:        Authority G.S. 108A‑25(b); 108A‑54; 42 C.F.R. 440.60;

Eff. February 1, 1976;

Amended Eff. September 30, 1977;

Readopted Eff. October 31, 1977;

Amended Eff. January 1, 2009; May 1, 1990; January 1, 1984;

Transferred from 10A NCAC 22O .0106 Eff. May 1, 2012.

10A NCAC 25P .0404       PODIATRIST SERVICES

The trimming of nails and corns shall not be covered.

History Note:        Authority G.S. 108A‑25(b); S.L. 1985, c. 479, s. 86; 42 C.F.R. 440.230(d);

Eff. February 1, 1976;

Readopted Eff. October 31, 1977;

Transferred from 10A NCAC 22O .0405 Eff. May 1, 2012.

10a NCAC 25P .0405       ABORTION

Lawful abortions shall be covered under Medicaid in accordance with federal law.

History Note:        Authority G.S. 108A‑25(b); 108A‑54; 108A‑56; 42 C.F.R. 440.90; 42 C.F.R. 441, Subpart E;

Eff. March 16, 1976;

Amended Eff. August 24, 1977;

Readopted Eff. October 31, 1977;

Recodified from 10 NCAC 26B .0115 Eff. October 1, 1993;

Recodified from 10 NCAC 26B .0116 Eff. January 1, 1998;

Transferred from 10A NCAC 22O .0117 Eff. May 1, 2012;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. July 23, 2016.

10A NCAC 25P .0406       LABORATORY AND X‑RAY SERVICES

History Note:        Authority G.S. 108A‑25(b); 108A‑54; 42 C.F.R. 440.30; 40 C.F.R. 441.16; 42 C.F.R. Part 493;

Eff. February 1, 1976;

Readopted Eff. October 31, 1977;

Amended Eff. March 1, 1993; April 1, 1992;

Transferred from 10A NCAC 22O .0104(1)-(3) Eff. May 1, 2012;

Expired Eff. August 1, 2016 pursuant to G.S. 150B-21.3A.