Other Facilities

Lab and X-ray Services Not Received in a Hospital

This includes lab and ultrasound services in a place other than a hospital outpatient unit.  CT, MRI, MRA, PET and SPECT must have prior authorization. 

What is a covered service?

  • All lab and X-ray services ordered and done by (or under the care of) a doctor
  • X-ray of the breast (mammogram)

Ambulatory Surgical Center Services

This is a facility that provides surgical services to patients that do not require a hospital stay.

What is a covered service?

  • Use of facility where procedure is performed
  • Prescription drugs used during the procedure
  • Surgical dressings, splints, casts
  • Equipment used during the surgical procedure
  • Materials for anesthesia

Hospice

Your PCP can ask for hospice care for you if you are terminally ill and not expected to live longer than six months.  This is an alternative to hospitalization.

Hospice will take care of all benefits that have to do with the terminal illness.  If you choose hospice, you give up the right to get other Medicaid services that have to do with the terminal illness.  If you choose hospice, you can change your mind at any time.

What is a covered service?

We cover these types of hospice care:

  • Nursing care
  • Doctor care
  • Medical care
  • Social services
  • Short-term inpatient care for pain control and to take care of symptoms
  • Durable medical equipment
  • Prescribed drugs
  • Counseling and bereavement services
  • Home health aide and homemaker services