Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 6142 (September 30, 2023).

55 Pa. Code § 1128.54. Noncompensable services and items.

§ 1128.54. Noncompensable services and items.

 The Department does not pay dialysis facilities for:

   (1)  Services that do not conform to this chapter.

   (2)  Services provided by a dialysis facility that does not meet the Federal Medicare requirements at 42 CFR 405.2100 (relating to scope of subpart).

   (3)  Services and items to the extent that payment is available through Medicare, other health insurance programs or financial resources.

   (4)  Diagnostic or therapeutic procedures solely for experimental, research or educational purposes.

   (5)  Procedures that are not listed in the MA Program fee schedule.

   (6)  Services that are not medically necessary.

   (7)  Services provided to recipients who are hospital inpatients.

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