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 § 1130.72. Payment for physicians’ services.

§ 1130.72. Payment for physicians’ services.

 (a)  The following services performed by hospice physicians are included in the level of care rates paid for a day of hospice care:

   (1)  General supervisory services of the medical director.

   (2)  Participation in the establishment of plans of care, supervision of care and services, periodic review and updating of plans of care and establishment of governing policies by the physician member of the interdisciplinary group.

 (b)  For physicians’ services not described in subsection (a), payment will be made to the hospice in accordance with the MA Program Fee Schedule.

 (c)  Services of the recipient’s attending physician are paid directly to that physician in accordance with the MA Program Fee Schedule if the physician is not an employe of the hospice or providing services under arrangement with the hospice.

 (d)  Services provided to treat a condition that is clearly unrelated to the terminal illness are not considered hospice services. The services are compensable to the appropriate provider in accordance with the applicable MA Program regulations.

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