Section 210.000. Program Coverage
- 016.06.3–210.100. Introduction
- 016.06.3–210.200. Definition, Scope and Coverage of Ambulatory Surgical Center (Asc) Services
- 016.06.3–210.210. Exclusions, Exceptions and Special Conditions
- 016.06.3–210.211. Facility Service Exclusions
- 016.06.3–210.212. Reserved
- 016.06.3–210.213. Physician Services
- 016.06.3–210.214. Laboratory, Radiology and Other Diagnostic Procedures
- 016.06.3–211.000. Introduction
- 016.06.3–212.000. Scope
- 016.06.3–215.000. Benefit Limits
- 016.06.3–215.100. Outpatient Surgery Benefit Limits
- 016.06.3–215.110. Benefit Limits for Laboratory, X-Ray and Machine Tests
- 016.06.3–215.111. Benefit Limits for Fetal Ultrasound and Fetal Non-Stress Tests
- 016.06.3–215.120. Benefit Extension Requests
- 016.06.3–215.121. Request for Extension of Benefits for Clinical, Outpatient, Laboratory and X-Ray Services, Form Dms-671
- 016.06.3–215.122. Documentation Requirements
- 016.06.3–215.123. Provider Notification of Benefit Extension Determinations 8–1–21
- 016.06.3–215.124. Reconsideration of Benefit Extension Denials
- 016.06.3–215.200. Appealing an Adverse Action
- 016.06.3–216.000. Coverage Limitations
- 016.06.3–216.100. Abortions
- 016.06.3–216.110. Abortion when the Life of the Mother Would be Endangered if the Fetus Were Carried to Term
- 016.06.3–216.120. Abortion when the Pregnancy is a Result of Rape or Incest
- 016.06.3–216.121. Procedure Codes for Abortion in the Case of Rape or Incest
- 016.06.3–216.200. Cosmetic Surgery
- 016.06.3–216.300. Sterilizations
- 016.06.3–216.310. Consent to Sterilization – Additional Information
- 016.06.3–216.400. Family Planning
- 016.06.3–216.410. Informed Consent for Hysterectomies
- 016.06.3–216.420. Random Audits of Hysterectomies
- 016.06.3–216.430. Hysterectomies Performed for Sterilization
- 016.06.3–216.500. Acknowledgement Statement for Hysterectomies and Sterilization Consent Form
- 016.06.3–216.600. Other Covered Asc Services
- 016.06.3–216.601. Cochlear Implants and External Sound Processors
- 016.06.3–216.602. Reserved
- 016.06.3–216.603. Organ or Disease Oriented Panels
- 016.06.3–216.604. Reserved
- 016.06.3–216.605. Reserved
- 016.06.3–216.700. Dental Surgery
- 016.06.3–216.800. Reserved
- 016.06.3–216.810. Reserved
- 016.06.3–216.820. Reserved
- 016.06.3–216.830. Reserved
- 016.06.3–216.900. Reserved