Regulations of Connecticut State Agencies
The department shall pay billing providers for the following physicians’ services:
(1) Those procedures that are medically necessary to treat the client’s condition;
(2) physicians’ services provided in an office, a general hospital, the client’s home, a chronic disease hospital, nursing facility, ICF/MR or other medical care facility;
(3) laboratory services provided by a provider in compliance with 42 USC 263a to 42 USC 263a-7, inclusive;
(4) medical and surgical supplies for out-of-office use by the client;
(5) drugs and devices administered by a provider;
(6) a second opinion for surgery or any other treatment when requested voluntarily by the client or when required by the department. The department shall pay for a second opinion according to the established fees for consultation;
(7) family planning, abortion and hysterectomy services as described in section 17b-262-348(r) of the Regulations of Connecticut State Agencies;
(8) Early and Periodic Screening, Diagnostic and Treatment services, including treatment services which are indicated following screening not otherwise covered, provided that prior authorization is obtained;
(9) surgical services necessary to treat morbid obesity as defined by the ICD that causes or aggravates another medical illness, including illnesses of the endocrine system or the cardio-pulmonary system, or physical trauma associated with the orthopedic system;
(10) family planning services for clients of childbearing age, including minors who can be considered sexually active, and who desire the services;
(11) sterilization for clients who are at least 21 years of age at the time of informed consent; and
(12) a hysterectomy performed during a period of retroactive eligibility as described in 42 CFR 441.255(e).
(Adopted effective January 31, 2008; Amended March 11, 2013)