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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 1806 (March 30, 2024).

55 Pa. Code § 1102.51. Reimbursement policy.


§ 1102.51. Reimbursement policy.

 (a)  Payment for services provided to Medical Assistance recipients is made by the Department directly to providers in a registered shared health facility. Payment is not made to another payee including the shared health facility.

 (b)  Payment is made to a provider only if the provider renders the service directly or if an employe of the provider renders the service under the direct supervision of the provider. For example, if a practitioner orders an X-ray and the X-ray is taken by someone other than the practitioner or an employe of the practitioner under the direct supervision of the practitioner, payment is not made to the practitioner for the ordered services.

 (c)  Payment is made only to enrolled physicians for radiology services and to enrolled laboratories for laboratory services.

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