Sec. 17b-262-342. Goods and services not covered

The department shall not pay for the following goods or services or goods or services related to the following:

(1) Transsexual surgery or for a procedure that is performed as part of the process of preparing an individual for transsexual surgery, such as hormone therapy and electrolysis;

(2) immunizations, biological products and other products available to providers free of charge;

(3) examinations and laboratory tests for preventable diseases that are furnished free of charge;

(4) information or services provided to a client by a provider electronically or over the telephone;

(5) cosmetic surgery;

(6) an office visit for the sole purpose of the client obtaining a prescription where the provider previously determined the need for the prescription;

(7) cancelled services and appointments not kept;

(8) services provided in a general hospital if the department determines the admission does not, or retrospectively did not, comply with the department’s utilization review requirements in section 17-134d-80 of the Regulations of Connecticut State Agencies;

(9) infertility treatment;

(10) sterilizations performed on mentally incompetent individuals or institutionalized individuals;

(11) more than one visit per day to the same provider by a client;

(12) services to treat obesity other than those described in section 17b-262-341(9) of the Regulations of Connecticut State Agencies; and

(13) any procedures or services of an unproven, educational, social, research, experimental or cosmetic nature; any diagnostic, therapeutic or treatment services in excess of those deemed medically necessary by the department to treat the client’s condition; or services not directly related to the client’s diagnosis, symptoms or medical history.

(Adopted effective January 31, 2008; Amended March 11, 2013)