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37.79.309    PHYSICIAN AND ADVANCED PRACTICE REGISTERED NURSE BENEFITS, LIMITATIONS AND EXCLUSIONS

(1) The services of physicians and advanced practice registered nurses are covered benefits.

(2) Prenatal care is covered as described for other medical conditions in these rules.

(3) Well baby, well child, and immunization services as recommended by the American academy of pediatrics and the advisory committee on immunizations practices are covered.

(4) Routine physicals for sports, employment or as required by a governmental authority are covered.

(5) Anesthesia services rendered by a physician-anesthesiologist (other than the attending physician or assistant) or by a nurse anesthetist are covered providing that surgical and/or hospital services are also covered.

(6) Hypnosis, local anesthesia, unless included in the procedure charge, and consultations prior to surgery are not covered.

(7) Surgical benefits are covered as described in ARM 37.79.307, 37.79.308 and this rule. In addition, professional services rendered by a physician, surgeon or doctor of dental surgery for treatment of a fractured jaw or other accidental injury to sound natural teeth and gums are covered.

(8) Medical or surgical treatment to reverse surgically induced infertility, fertility enhancing procedures beyond diagnosis and sex change operations are excluded.

(9) Medically appropriate second opinions which may include major diagnoses or courses of treatment are a covered benefit.

History: Sec. 53-4-1009, MCA; IMP, Sec. 53-4-1003, MCA; NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04.

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