Library: Policy

317:30-5-1099. I/T/U service limitations and requirements

Revised 9-14-20

Service limitations governing the provision of all Oklahoma SoonerCare services will apply pursuant to Chapter 30 of the OHCA rules. In addition, the following limitations and requirements apply to services provided by I/T/U facilities:

(1) Multiple encounters. An I/T/U facility may bill for more than one encounter per twenty-four (24) hour period under certain conditions.

(2) Behavioral Health services. Behavioral Health Services are limited to those services furnished to members at or on behalf of the I/T/U facility.

(3) Laboratory procedures. Laboratory procedures performed by an I/T/U outpatient facility (not an independently certified enrolled laboratory) on the same date of service are considered part of the health care practitioner's service and are included in the I/T/U encounter.

(4) Obstetrical services. For OB services provided to a member before, during, and/or after the same pregnancy, ITUs may not bill for individual encounters and the package/bundled rate. Providers may only either:

(A) bill for antepartum visits, postpartum visits, and/or a cesarean or vaginal delivery as individual encounter; or

(B) bill the packaged/bundled rate for total care obstetrics, (which includes antepartum and postpartum visits and delivery). Refer to Oklahoma Administrative Code 317:30-5-22 for more detailed obstetrical care policy.