Sec. 10.09.87.05. Limitations

The Program does not cover the following:

A. Services for which the IDTF provider cannot supply a properly completed order identifying the authorized ordering practitioner by National Provider Identifier (NPI);

B. IDTF services ordered by an:

(1) Individual who is not enrolled as a provider in the Program with an active status on the date of service; and

(2) Entity, facility, or another provider that is not an individual.

C. Services not adequately documented in the recipient’s medical record;

D. Services not medically necessary;

E. Procedures that are the provider as investigational or experimental in nature;

F. Services which are specifically included as an integral part of another service;

G. Consultations;

H. Office Visits;

I. Injections;

J. Surgeries; and

K. Therapeutic services.