Section 104.04. Second opinion program.

 

(1)   Purpose. Under s. 49.45 (3) (i) , Stats., the department shall require a second medical opinion for selected elective surgical procedures, in order to provide a recipient additional medical information about the medical appropriateness of the proposed procedure before the recipient makes a decision to undergo the procedure. Procedures for which a second medical opinion is required are the following:

(a) Cataract extraction, with or without lens implant;

(b) Cholecystectomy;

(c) Non-obstetrical D and C;

(d) Hemorrhoidectomy;

(e) Hernia repair, inguinal;

(f) Hysterectomy;

(g) Joint replacement, hip or knee;

(h) Tonsillectomy;

(i) Adenoidectomy; and

(j) Varicose vein surgery.

(2)   Applicability. The requirement for a second opinion applies only to nonemergency procedures.

(3)   Sanctions.

(a) If a provider performs an elective surgical procedure covered under the program and no second opinion has been obtained, the primary surgeon's fees are not reimbursable by MA.

(b) If the provider who provides the second opinion also performs the surgery, the primary surgeon's fees are not reimbursable by MA.

History: Cr. Register, December, 1979, No. 288 , eff. 2-1-80; am. Register, February, 1986, No. 362 , eff. 3-1-86.

Note

Section 49.45 (3) (i), Stats., was repealed by 2005 Wis. Act 25 . Microsoft Windows NT 6.1.7601 Service Pack 1