section .0200 inpatient hospital services



Coverage for selected elective surgical procedures is contingent upon the rendering of a second opinion by another qualified practitioner when Medicaid is the primary payor. Categories of surgery which may be subject to a second surgical opinion requirement include hysterectomy, cholocystectomy, hemorrhoidectomy, knee surgery, coronary bypass, foot surgery, laminectomy, prostatectomy, tonsillectomy and adenoidectomy, inguinal hernia repair, varicose vein stripping and cataract surgery. This requirement may be waived by the state agency under the following conditions:

(1) Subsequent to the performance of the procedure the recipient is determined to be retroactively eligible;

(2) Unanticipated circumstances precluded performance of a second surgical opinion;

(3) Physician developed criteria precludes a second opinion.


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.