(1) These requirements are in addition to those requirements contained in ARM 37.85.401 through 37.85.414.

(2) Clinic services must be provided by a clinic which is licensed as an outpatient facility by the appropriate licensing entity of the state where the facility is located and meet the requirement for participation in Medicare.

(3) Clinic services must be provided by, or under the direction of a licensed physician or, where appropriate a licensed dentist.

(4) Conditions for coverage of listed ambulatory surgical center procedures:

(a) Covered surgical procedures are limited to those procedures that do not generally exceed:

(i) a total of 90 minutes operating time; and

(ii) a total of four hours recovery or convalescent time.

(b) If the covered surgical procedure requires anesthesia, the anesthesia must be:

(i) local or regional anesthesia; or

(ii) general anesthesia of 90 minutes or less duration.

(c) Covered surgical procedures may not be of a type that:

(i) generally result in extensive blood loss;

(ii) requires a major or prolonged invasion of body cavities;

(iii) directly involves major blood vessels;

(iv) are generally emergency or life threatening in nature; or

(v) can safely be performed in a physician's or dentist's office.

(d) Covered surgical procedures can only be rendered by a licensed ambulatory surgical center.

(5) Telephone contacts are not a clinic service.