Section 217.000. Coverage Limitations.

• 016.06.20–217.010. Abortions.
• 016.06.20–217.011. Abortions when the Life of the Mother Would be Endangered if the Fetus Were Carried to Term.
• 016.06.20–217.012. Abortion for Pregnancy Resulting from Rape or Incest.
• 016.06.20–217.113 Gastrointestinal Tract Imaging with Endoscopy Capsule
• 016.06.20–217.020. Cosmetic Surgery.
• 016.06.20–217.030. Dental Treatment.
• 016.06.20–217.040. Bariatric Surgery for Treatment of Morbid Obesity
• 016.06.20–217.050. Hysterectomies.
• 016.06.20–217.060. Transplants 8–1–21
• 016.06.20–217.061. Bone Marrow Transplants.
• 016.06.20–217.062 Corneal Transplants
• 016.06.20–217.063. Heart Transplants 8–1–21
• 016.06.20–217.064. Liver Transplants 8–1–21
• 016.06.20–217.065. Liver/Bowel Transplants 8–1–21
• 016.06.20–217.066. Lung Transplants 8–1–21
• 016.06.20–217.067. Kidney (Renal) Transplants.
• 016.06.20–217.068. Pancreas/Kidney Transplants.
• 016.06.20–217.069. Skin Transplants.
• 016.06.20–217.090 Bilaminate Graft or Skin Substitute Coverage Restriction
• 016.06.20–217.100. Observation Bed Status and Related Ancillary Services.
• 016.06.20–217.110. Determining Inpatient and Outpatient Status.
• 016.06.20–217.111. Medical Necessity Requirements.
• 016.06.20–217.112. Services Affected by Observation Policy.
• 016.06.20–217.120. Cochlear Implants.
• 016.06.20–217.130. Hyperbaric Oxygen Therapy (Hbot) 8–1–21
• 016.06.20–217.140. Verteporfin (Visudyne).
• 016.06.20–217.141 Computed Tomographic Colonography (CT Colonography)
• 016.06.20–217.150. Vagus Nerve Stimulation
• 016.06.20–218.000. Guidelines for Retrospective Review of Occupational, Physical and Speech Therapy Services 8–1–21
• 016.06.20–218.100. Guidelines for Retrospective Review of Occupational and Physical Therapy for Beneficiaries Under the Age of 21
• 016.06.20–218.101. Documenting Evaluations.
• 016.06.20–218.102. Standardized Testing.
• 016.06.20–218.103. Other Objective Tests and Measures.
• 016.06.20–218.104. Progress Notes.
• 016.06.20–218.105. Frequency, Intensity and Duration of Therapy Services.
• 016.06.20–218.106. Duration of Services.
• 016.06.20–218.107. In-Home Maintenance Therapy.
• 016.06.20–218.108. Monitoring in-Home Maintenance Therapy.
• 016.06.20–218.110. Therapy Services for Beneficiaries Under Age 21 in Child Health Services (EPSDT)
• 016.06.20–218.115. Speech-Language Therapy Services for Beneficiaries up to Age 19 in Arkids First — B
• 016.06.20–218.120. Accepted Tests for Occupational Therapy
• 016.06.20–218.130. Accepted Tests for Physical Therapy.
• 016.06.20–218.200. Speech-Language Therapy Guidelines for Retrospective Review for Beneficiaries Under Age 21
• 016.06.20–218.210. Accepted Tests for Speech-Language Therapy.
• 016.06.20–218.220. Intelligence Quotient (IQ) Testing.
• 016.06.20–218.250. Process for Requesting Extended Therapy Services for Beneficiaries Under Twenty-One (21) Years of Age
• 016.06.20–218.260. Documentation Requirements.
• 016.06.20–218.270. Extended Therapy Services Review Process 8–1–21
• 016.06.20–218.280. Administrative Reconsideration 8–1–21
• 016.06.20–218.300. Retrospective Review of Paid Therapy Services.
• 016.06.20–218.301. Medical Necessity Review.
• 016.06.20–218.302. Utilization Review.
• 016.06.20–218.303. Reconsideration Review.
• 016.06.20–218.400. Acute Crisis Units