Section 215.000. Benefit Limitations for Outpatient Hospital Services.

• 016.06.20–215.010. Benefit Limit for Emergency Services.
• 016.06.20–215.020. Benefit Limit for Non-Emergency Services.
• 016.06.20–215.021. Benefit Limit for Occupational, Physical, and Speech-Language Therapies for Beneficiaries 21 Years of Age and Older
• 016.06.20–215.030. Benefit Limit for Outpatient Assessment in the Emergency Department.
• 016.06.20–215.040. Benefit Limit in Outpatient Diagnostic Laboratory and Radiology/Other Procedures.
• 016.06.20–215.041. Benefit Limits for Fetal Non-Stress Test and Fetal Ultrasound.
• 016.06.20–215.100. Benefit Extension Requests
• 016.06.20–215.101. Request for Extension of Benefits for Clinical, Outpatient, Diagnostic Laboratory, and Radiology/Other Services, Form Dms–671.
• 016.06.20–215.102. Documentation Requirements.
• 016.06.20–215.103. Provider Notification of Benefit Extension Determinations 8–1–21
• 016.06.20–215.104. Reconsideration of Benefit Extension Denials.
• 016.06.20–215.110. Appealing an Adverse Action.
• 016.06.20–215.200. Exclusions - Outpatient.
• 016.06.20–215.300. Non-Covered Services
• 016.06.20–215.301. Routine Standard of Care Associated with Qualifying Clinical Trials
• Section 215.400. Critical Access Hospitals (CAH) Coverage.