R414-3A-5. Services

  (1) Services appropriate in the outpatient hospital setting encompass medically necessary diagnostic, therapeutic, rehabilitative, or palliative medical services and supplies.

  (2) Outpatient hospital services include:

  (a) the service of nurses or other personnel necessary to complete the service and provide member care during the provision of service;

  (b) the use of hospital facilities, equipment, and supplies; and

  (c) the technical portion of clinical laboratory and radiology services.

  (3) Cosmetic or reconstructive procedures are set forth in Section R414-1-29.

  (4) Coverage of sleep studies requires sleep center accreditation through one of the following nationally recognized accreditation organizations:

  (a) American Academy of Sleep Medicine (AASM);

  (b) Accreditation Commission for Health Care (ACHC); or

  (c) The Joint Commission (TJC).

  (5) Hyperbaric oxygen therapy is limited to service in a facility in which the hyperbaric unit is accredited by the Undersea and Hyperbaric Medical Society. Hyperbaric oxygen therapy is therapy that places the member in an enclosed pressure chamber for medical treatment.