Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 8238 (December 30, 2023).

55 Pa. Code § 1123.61. Noncompensable services and items.

§ 1123.61. Noncompensable services and items.

 Payment will not be made for the following services and items:

   (1)  Items and services not listed in the Medical Assistance program fee schedule.

   (2)  Eyeglasses for individuals 21 years of age or older.

   (3)  Prescription sunglasses.

   (4)  Tinted lenses.

   (5)  Tennis shoes, sneakers, slippers, sandals or another type of footwear that does not fit the description of the orthopedic shoe or molded shoe established in §  1123.2 (relating to definitions).

   (6)  Surgical supplies and durable medical equipment for persons in skilled nursing and intermediate care facilities.

   (7)  Repairs or modifications to shoes other than orthopedic shoes as defined in §  1123.2 except for the insertion of orthotic devices.

   (8)  Orthotic devices for orthopedic or molded shoes.

   (9)  Items prescribed or ordered by a practitioner who has been barred or suspended during an administrative action from participation in the Medical Assistance Program. The Department will, periodically, send medical suppliers a list of names of suspended, terminated or reinstated practitioners and the dates of the various actions. Medical suppliers are responsible for checking this list before providing services.

   (10)  Orthopedic shoes for individuals 21 years of age or older.

Source

   The provisions of this §  1123.61 adopted May 9, 1980, effective July 1, 1980, 10 Pa.B. 1882; amended September 26, 1980, effective October 1, 1980, 10 Pa.B. 3796; 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 (99327).

Cross References

   This section cited in 55 Pa. Code §  1123.51 (relating to general payment policy).



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