part ii policies and procedures for rural health clinic services

4. ResidentialRev 01/09Clinics may be reimbursed for services rendered in a patient‟s homes whensuch services are included in the procedure codes listed in Appendix F and arerendered by an RHC physician, who is compensated under agreement by theclinic for providing services to the clinic patients in a location other than at theclinic‟s facility.Visits to homebound members by Visiting Nurse are reimbursable whenrendered in accordance with Section 903.9 of this manual.907. Non-Covered ServicesThe following services or procedures are non-covered RHC services. This list isindicative of non-covered services and is not meant to be exhaustive:1. Services that are prohibited by Certification or Licensure.2. All procedure codes listed in the CPT-4 as “unlisted procedures” which end in“99”.3. Services and/or procedures performed without regard to the policies containedin this Policy Manual;4. Services normally provided free of charge to patients.5. Clinic visits for photographs.6. Medcosonolator or medotherm.7. Experimental procedures.8. Services that are not medically necessary.9. Laboratory or radiology services which are not performed in conjunction witha clinic visit.10. Substance Abuse Clinic Services.11. Vaccines for members less than nineteen years of age that are availablethrough the VFC program.January 2012 Rural Health Clinic Services IX-12