Sec. 10.14.02.15. Medical Management Fee

A. A participating health care provider eligible to receive a medical management fee may be one of the following:

(1) Anesthesiologist;

(2) Certified nurse midwife;

(3) Family practitioner;

(4) Gynecologist;

(5) Medical internist;

(6) Medical oncologist;

(7) Nurse anesthetist;

(8) Nurse practitioner;

(9) Pathologist;

(10) Physician assistant;

(11) Radiation oncologist;

(12) Radiologist;

(13) Surgeon; and

(14) Participating health care provider who renders services pursuant to §B of this regulation.

B. The Department shall reimburse a participating health care provider as outlined in §A of this regulation a medical management fee of $50 each time a reimbursed service:

(1) Is in compliance with the medical guidelines pursuant to Regulation .04A(7)(a)-(f) of this chapter;

(2) Involves a consult with an oncologist pursuant to Regulation .04A(7)(g) and (h) of this chapter;

(3) Is in compliance with the medical care management guidelines pursuant to Regulation .04A(6) of this chapter; or

(4) Is billed with the medical management fee for reporting and includes a copy of the relevant medical report including, but not limited to:

(a) Radiology;

(b) Biopsy;

(c) Operative; or

(d) Staging.

C. The Program shall reimburse for claims pursuant to this regulation as set forth in Regulation .21 of this chapter.