HI 00620.001 General Exclusions

No payment can be made under either the hospital insurance or SMI program for certain items and services:

  1. A. 

    Not reasonable and necessary (HI 00620.010);

  2. B. 

    No legal obligation to pay or provide services (HI 00620.020);

  3. C. 

    Paid for by a governmental entity (HI 00620.030);

  4. D. 

    Not provided within the United States (HI 00620.080);

  5. E. 

    Resulting from war (HI 00620.090);

  6. F. 

    Personal comfort (HI 00620.100);

  7. G. 

    Routine services and appliances (HI 00620.110);

  8. H. 

    Supportive devices for feet (HI 00620.120);

  9. I. 

    Custodial care (HI 00620.130);

  10. J. 

    Cosmetic surgery (HI 00620.140);

  11. K. 

    Charges by immediate relatives or members of household (HI 00620.150);

  12. L. 

    Dental services (HI 00620.160);

  13. M. 

    Paid or expected to be paid under workers' compensation (HI 00620.170);

  14. N. 

    Paid or expected to be paid under automobile medical or no-fault insurance or paid under liability insurance (HI 00620.175);

  15. O. 

    Covered by employer plans for end-stage renal disease beneficiaries and beneficiaries age 65-69 (working aged) and their spouses age 65-69 (HI 00620.177);

  16. P. 

    Excluded foot care (HI 00620.180);

  17. Q. 

    Application of foot care exclusion to physicians' services(HI 00620.190)

  18. R. 

    Exclusions of refractive services (HI 00620.200).

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HI 00620.001 - General Exclusions - 03/11/1999
Batch run: 03/11/1999