Sec. 2.5. (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.
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.
Structure Indiana Code
Chapter 15. Payment to Hospitals; General
12-15-15-1. Services at Hospitals Licensed Under Ic 16-21; Rates Established Under Rules
12-15-15-1.2. Reimbursement for Children's Hospital Bordering Indiana; Limitations; Expiration
12-15-15-1.5. Additional Reimbursements to Certain Hospitals; Appeal of Amount of Distribution
12-15-15-1.6. Alternative Payment Methodology for Payments to Hospitals
12-15-15-2.5. Payment for Physician Services in Emergency Department
12-15-15-3. Services Provided at Hospitals Operating Under Ic 16-24-1; Prospective Payment Rate
12-15-15-4. Per Diem Rate for Services Provided in Hospitals Operating Under Ic 16-24-1
12-15-15-4.5. Payment for HIV Test; Limitation
12-15-15-6. Fees in Addition to Infant Delivery Fees
12-15-15-9.6. Limitation on Total Amount of Payments
12-15-15-10. Payments to Providers Under Medicaid Disproportionate Share Provider Program