405 IAC 5-14-6
405 IAC 5-14-6 Prophylaxis
Cite as Ind. Admin. Code tit. 405, r. 5-14-6
Sec. 6. Prophylaxis is a covered service in accordance with the following limitations:
(1) One (1) unit every six (6) months for noninstitutionalized members twelve (12) months of age up to their twenty-first
birthday.
(2) One (1) unit every twelve (12) months for noninstitutionalized members twenty-one (21) years of age and older.
(3) Institutionalized members may receive up to one (1) unit every six (6) months.
(4) Prophylaxis is not covered for members under twelve (12) months of age.