Sec. 10.20.01.05. Preauthorization

A. The following procedures or services require preauthorization:

(1) Treatment that is provided outside of Maryland;

(2) Pre-renal transplant dental services;

(3) Ancillary supplies for home intravenous antibiotic therapy;

(4) Durable medical equipment and disposable medical supplies used in the home; and

(5) One pair of eyeglasses, one time only.

B. The Program may preauthorize services when the provider submits to the Program adequate documentation demonstrating that the service to be preauthorized is directly related to treatment of the recipient's ESRD.

C. Renal transplantation services provided to a recipient outside of Maryland are not eligible for reimbursement unless the Commission gives prior written approval for the transplant.

D. The Program does not cover:

(1) Any service denied by Medicare as not medically justified or any services covered by Medical Assistance; or

(2) Services which are investigational or experimental.

E. In cases of multiple organ transplants, Program coverage shall be limited to only those services related to transplantation of the kidney. The provider shall break out and satisfactorily document the charges related to the kidney transplant before submitting a reimbursement request to the Program.