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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 § 1123.51. General payment policy.


§ 1123.51. General payment policy.

 Payment is made for covered services provided by participating providers subject to the conditions and limitations established in this section, § §  1123.52 and 1123.60—1123.62, and Chapters 1101 and 1150 (relating to general provisions; and MA Program payment policies) and the MA Program fee schedule. Items and services shall be prescribed by a licensed medical practitioner and prescriptions and orders shall specify the patient’s diagnosis. Payment will not be made for a compensable medical supply if payment is available from another agency or another insurance or health program.


   The provisions of this §  1123.51 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 page (99322).

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