§ 12-15-15-2.5 — Payment for physician services in emergency department

Indiana § 12-15-15-2.5

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 15: Payment to Hospitals; General

Text

5. (a) Payment for physician services
provided in the emergency department of a hospital licensed under IC 16-21 must be at a rate of one hundred percent (100%) of rates payable
under the Medicaid fee structure.
(b) The payment under subsection (a) must be calculated using the
same methodology used for all other physicians participating in the
Medicaid program.
(c) For services rendered and documented in an individual's medical
record, physicians must be reimbursed for federally required medical
screening exams that are necessary to determine the presence of an
emergency using the appropriate Current Procedural Terminology
(CPT) codes 99281, 99282, or 99283 described in the Current
Procedural Terminology Manual published annually by the American
Medical Association, without authorization by the enrollee's primary
medical provider.
(d) This section does not apply to a person enrolled in a Medicaid
risk based managed care program.

Legislative History

As added by P.L.153-1995, SEC.10. Amended by P.L.119-1997, SEC.5; P.L.245-1999, SEC.1; P.L.223-2001, SEC.10; P.L.152-2017, SEC.23.