HI 00620.000 Exclusions from Coverage

Subchapter Table of Contents
Section   Latest
Transmittal
HI 00620.001 General Exclusions
HI 00620.010 Services Not Reasonable and Necessary
HI 00620.020 No Obligation to Pay for or Provide Services TN 14 02-23
HI 00620.030 Items and Services Furnished or Paid for by Governmental Entities
HI 00620.040 Items and Services Furnished by a Federal Provider of Services or Federal Agency
HI 00620.050 Items and Services which a Provider, Physician or Supplier is Obligated to Furnish at Public Expense Pursuant to an Authorization Issued by a Federal Agency TN 13 11-22
HI 00620.060 Items or Services Which are Paid For by a Governmental Entity TN 13 11-22
HI 00620.070 Illustrations TN 13 11-22
HI 00620.080 Services Not Provided Within the United States TN 15 04-24
HI 00620.090 Services Resulting From War
HI 00620.100 Personal Comfort Items TN 13 11-22
HI 00620.110 Routine Services and Appliances
HI 00620.120 Supportive Devices for Feet
HI 00620.130 Custodial Care TN 13 11-22
HI 00620.140 Cosmetic Surgery TN 12 10-89
HI 00620.150 Charges Imposed by Immediate Relatives of the Patient or Members of His Household TN 14 02-23
HI 00620.160 Dental Services Exclusion TN 12 10-89
HI 00620.170 Workers' Compensation TN 12 10-89
HI 00620.171 Private Right of Action TN 12 10-89
HI 00620.175 Services Reimbursable Under Automobile, No-Fault, or Any Liability Insurance TN 13 11-22
HI 00620.177 Medicare as Secondary Payer for End Stage Renal Disease (ESRD) Beneficiaries and for Employed Beneficiaries Age 65 or Over (Working Aged) and the Spouses Age 65 or Over of Employed Individuals of Any Age TN 13 11-22
HI 00620.178 Medicare as Secondary Payer for Disabled Individuals TN 13 11-22
HI 00620.180 Excluded Foot Care Services
HI 00620.190 Application of Foot Care Exclusion to Physicians' Services
HI 00620.200 Exclusion of Refractive Services

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HI 00620.000 - Exclusions from Coverage - Table of Contents - 04/03/2024
Batch run: 04/05/2024
Rev:04/03/2024