Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

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55 Pa. Code § 1123.2. Definitions.

§ 1123.2. Definitions.

 The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

   Durable medical equipment—An item or device listed in the Medical Assistance program fee schedule that can withstand repeated use; which are used primarily and customarily to serve a medical purpose; which are customarily not useful to a person in the absence of illness or injury and which are appropriate for home use.

   Hemophilia products—Items which are used in the treatment of hemophilia limited to those products listed in the Medical Assistance program fee schedule.

   Medical supplies—Items specified in this chapter or the Medical Assistance program fee schedule as being compensable under the Medical Assistance program. The items include surgical supplies, durable medical equipment, orthoses, prostheses, visual and hearing aids and hemophilia products.

   Molded shoes—Shoes listed in the Medical Assistance program fee schedule constructed from a special last conforming to a specific individual’s foot. Molded shoes shall be constructed from leather or other durable material.

   Orthopedic shoes—Shoes listed in the Medical Assistance program fee schedule that have a Goodyear welt, steel shank and elongated medical counter which are modified to compensate for an abnormality of the foot. Various modifications, such as wedges, can be applied to or put inside this basic orthopedic shoe. The Department’s established fee for orthopedic shoes includes modifications except for those necessary to apply a brace or splint to the shoe.

   Orthoses—Items listed in the Medical Assistance program fee schedule that are used to support, align, prevent or correct deformities or to improve the functions of movable parts of the body.

   Prostheses—An item which substitutes or replaces missing parts of the body.

   Shoe inserts—Devices listed in the Medical Assistance program fee schedule that are constructed of plexiglass, hard plastic or other rigid material fashioned for the individual foot by a laboratory approved to participate in the Medical Assistance program. An orthotic device shall be fabricated according to the specifications written on the prescription by the client’s physician.

   Surgical supplies—An item intended for direct application to the body as an aid to ameliorate a diagnosed medical condition.

   Visual aids—An item which is used to correct or improve the function of the eye.

Source

   The provisions of this §  1123.2 adopted May 9, 1980, effective July 1, 1980, 10 Pa.B. 1882; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932; amended September 30, 1988, effective October 1, 1988, 18 Pa.B. 4418. Immediately preceding text appears at serial pages (99319) and (99320).

Cross References

   This section cited in 55 Pa. Code §  1123.2a (relating to clarification of the term ‘‘written’’—statement of policy); 55 Pa. Code §  1123.22 (relating to scope of benefits for the medically needy); and 55 Pa. Code §  1123.61 (relating to noncompensable services and items).



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