How many visit Maximum per year - insurance allowed for
office and ESRD
Limitations on Services
Within each calendar year each recipient is limited to no
more than a total of 14 physician visits in offices, hospital outpatient
settings, nursing facilities, rural health clinics or Federally Qualified
Health Centers. Visits not counted under this benefit limit will include, but
not be limited to, visits for: EPSDT, prenatal care, postnatal care, and family
planning. Physicians services provided in a hospital outpatient setting that
have been certified as an emergency do not count against the physician benefit
limit of 14 per calendar year. If a patient receives ancillary services in a
doctor's office, by the physician or under his/her direct supervision, and
the doctor submits a claim only for the ancillary services but not for the
office visit, then the services provided will not be counted as a visit.
