405 IAC 5-8-4 Confirmatory consultations

Sec. 4. (a) A confirmatory consultation is the rendering of a second or third medical opinion, completed by a physician for a specific member, regarding evaluation or management of a condition. (b) A confirmatory consultation may be billed to Medicaid only when it is specifically requested by another physician or the office. (c) A confirmatory consultation to substantiate that the service is medically necessary may be required as part of the prior authorization process.