WAC 388-531-0150   Noncovered physician-related services -- General and administrative.  (1) Except as provided in WAC 388-531-0100 and subsection (2) of this section, MAA does not cover the following:

     (a) Acupuncture, massage, or massage therapy;

     (b) Any service specifically excluded by statute;

     (c) Care, testing, or treatment of infertility, frigidity, or impotency. This includes procedures for donor ovum, sperm, womb, and reversal of vasectomy or tubal ligation;

     (d) Cosmetic treatment or surgery, except for medically necessary reconstructive surgery to correct defects attributable to trauma, birth defect, or illness;

     (e) Experimental or investigational services, procedures, treatments, devices, drugs, or application of associated services, except when the individual factors of an individual client's condition justify a determination of medical necessity under WAC 388-501-0165;

     (f) Hair transplantation;

     (g) Marital counseling or sex therapy;

     (h) More costly services when MAA determines that less costly, equally effective services are available;

     (i) Vision-related services listed as noncovered in chapter 388-544 WAC;

     (j) Payment for body parts, including organs, tissues, bones and blood, except as allowed in WAC 388-531-1750;

     (k) Physician-supplied medication, except those drugs administered by the physician in the physician's office;

     (l) Physical examinations or routine checkups, except as provided in WAC 388-531-0100;

     (m) Routine foot care. This does not include clients who have a medical condition that affects the feet, such as diabetes or arteriosclerosis obliterans. Routine foot care includes, but is not limited to:

     (i) Treatment of mycotic disease;

     (ii) Removal of warts, corns, or calluses;

     (iii) Trimming of nails and other hygiene care; or

     (iv) Treatment of flat feet;

     (n) Except as provided in WAC 388-531-1600, weight reduction and control services, procedures, treatments, devices, drugs, products, gym memberships, equipment for the purpose of weight reduction, or the application of associated services.

     (o) Nonmedical equipment; and

     (p) Nonemergent admissions and associated services to out-of-state hospitals or noncontracted hospitals in contract areas.

     (2) MAA covers excluded services listed in (1) of this subsection if those services are mandated under and provided to a client who is eligible for one of the following:

     (a) The EPSDT program;

     (b) A medicaid program for qualified medicare beneficiaries (QMBs); or

     (c) A waiver program.



[Statutory Authority: RCW 74.08.090, 74.09.520. 05-12-022, § 388-531-0150, filed 5/20/05, effective 6/20/05; 01-01-012, § 388-531-0150, filed 12/6/00, effective 1/6/01.]