# COMAR 10.09.94.05: COMAR 10.09.94.05. Limitations

> Maryland · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_05

## Section

- **Citation:** COMAR 10.09.94.05
- **Heading:** COMAR 10.09.94.05. Limitations
- **Jurisdiction:** Maryland
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Code of Maryland Regulations / Title 10 MARYLAND DEPARTMENT OF HEALTH / Subtitle 09 MEDICAL CARE PROGRAMS / Chapter 94 Special Pediatric Hospitals / COMAR 10.09.94.05

## Text

The Program does not cover:
A. Investigational or experimental hospital services, procedures, or drugs;
B. Inpatient admissions or outpatient visits solely for the administration of injections, unless medical necessity and the participant’s inability to take appropriate oral medications is documented in the participant’s medical record;
C. Outpatient visits intended to accomplish one or more of the following:
(1) Prescription drug or food supplement pick-up;
(2) Collection of specimens for laboratory procedures;
(3) Recording of an electrocardiogram; or
(4) Ascertaining the participant’s weight;
D. Interpretation of laboratory tests or panels;
E. Autopsies;
F. Immunizations required for travel outside the continental United States;
G. Leaves of absence beyond the period of the census check of the same day;
H. Day care;
I. Psychological evaluations and treatments except when:
(1) Ordered by a physician, and the medical necessity is documented in the participant’s medical record; or
(2) Performed as mental health service, as part of the plan of treatment;
J. Duplicated care or services;
K. Elective admissions to hospitals outside of Maryland and the District of Columbia unless the Department or its designee determines that comparable services are not available in Maryland, except under certain conditions where child participants are in foster care, or are for other reasons placed outside the State and are covered under certain criteria, as determined by the Department or its designee;
L. Inpatient and outpatient diagnostic services not specifically ordered by the attending physician or other responsible practitioner;
M. Inpatient days or services provided in excess of the days approved by the Department or its designee;
N. Hospital laboratory tests which are coverable under COMAR 10.09.09.04 , if the specimen is not obtained in the hospital;
O. Hospital services provided outside of the United States;
P. The completion of forms and reports;
Q. Broken or missed appointments;
R
or other responsible practitioner;
M. Inpatient days or services provided in excess of the days approved by the Department or its designee;
N. Hospital laboratory tests which are coverable under COMAR 10.09.09.04 , if the specimen is not obtained in the hospital;
O. Hospital services provided outside of the United States;
P. The completion of forms and reports;
Q. Broken or missed appointments;
R. Professional services rendered by mail or telephone; or
S. Telephones, televisions, or personal comfort items or services.

## Nearby sections

- [COMAR 10.09.94.01 COMAR 10.09.94.01. Definitions](https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_01.md)
- [COMAR 10.09.94.02 COMAR 10.09.94.02. License Requirements](https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_02.md)
- [COMAR 10.09.94.03 COMAR 10.09.94.03. Conditions for Participation](https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_03.md)
- [COMAR 10.09.94.04 COMAR 10.09.94.04. Covered Services](https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_04.md)
- [COMAR 10.09.94.05 COMAR 10.09.94.05. Limitations](https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_05.md)
- [COMAR 10.09.94.06 COMAR 10.09.94.06. Utilization Review](https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_06.md)
- [COMAR 10.09.94.07 COMAR 10.09.94.07. Payment Procedures](https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_07.md)
- [COMAR 10.09.94.08 COMAR 10.09.94.08. District of Columbia Hospital Reimbursement](https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_08.md)
- [COMAR 10.09.94.09 COMAR 10.09.94.09. Billing and Reimbursement Principles](https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_09.md)
- [COMAR 10.09.94.10 COMAR 10.09.94.10. Recovery and Reimbursement](https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_10.md)
- [COMAR 10.09.94.11 COMAR 10.09.94.11. Cause for Suspension or Removal and Imposition of Sanctions](https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_11.md)
- [COMAR 10.09.94.12 COMAR 10.09.94.12. Appeal Procedures](https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_12.md)
- [COMAR 10.09.94.13 COMAR 10.09.94.13. Interpretive Regulation](https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_13.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_MD_COMAR_10_09_94_05. Check the current official text before relying on it. Not legal advice.