10A NCAC 25P .0402        CLINIC SERVICES

(a)  Clinic services for which the physician or dentist files directly for payment shall not be covered.

(b)  Clinic services specifically covered in other Title XIX programs shall not be covered.

(c)  Clinic services provided at hospital clinics or at volunteer clinics not affiliated with the county health department shall not be covered, regardless of the amount of assistance provided by the county health department.

(d)  Medicaid payments for dental services in clinics shall cover only those dental procedures which do not require prior approval.  All dental services requiring prior approval must be billed separately, using the dentist's own provider number and the appropriate prior approval form.

(e)  Only clinic services furnished by or under the direction of a physician or dentist shall be covered.


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.