(1) The medicaid agency separately pays the physician or qualified health care professional (QHCP) for professional services provided by the physician or QHCP in a hospital inpatient observation setting during the surgical follow-up period only if the services are performed for an emergency condition or a diagnosis that is unrelated to the inpatient stay.
(2) The agency pays for one physician or QHCP service provided in a hospital inpatient observation setting per client, per day for the same or related diagnoses. If a service is included in the global surgery reimbursement, the agency does not pay separately.
(3) The agency pays for a hospital admission related to a planned surgery through the global fee for surgery, if applicable.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 26-17-080, s 182-531-0750, filed 8/17/26, effective 9/17/26. WSR 11-14-075, recodified as § 182-531-0750, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 10-19-057, § 388-531-0750, filed 9/14/10, effective 10/15/10. Statutory Authority: RCW 74.08.090, 74.09.520. WSR 01-01-012, § 388-531-0750, filed 12/6/00, effective 1/6/01.]