§ 1143.2. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Chronic conditionAn illness which frequently recurs or persists for a period in excess of 3 months.
Compensable serviceA benefit to which a MA recipient is entitled under the MA Program.
ConsultationA medical evaluation conducted by a specialist at the request of the attending practitioner. For the purposes of the MA Program, a consultation includes taking a medical history, examining the patient, and preparing a written report that is incorporated into the patients record.
Experimental procedureA procedure that deviates from customary standards of medical practice, is not routinely used in the medical or surgical treatment of a specific illness or condition, or is not of proven medical value.
Medical justificationWritten documentation in the patients medical record indicating the specific health condition or risk that makes the particular service the podiatrist renders, orders or prescribes medically necessary.
Medically necessaryA term used to describe those medical conditions for which treatment is necessary, as determined by the Department, and which are compensable under the MA Program.
Molded shoesShoes that are constructed from a special last conforming to a specific individuals feet. Molded shoes are constructed from leather or other durable material.
Noncompensable serviceA service a provider furnishes for which there is no provision for payment under this chapter.
Nonemergency medical servicesA compensable podiatrists service provided for conditions not requiring immediate medical intervention in order to sustain the life of the person or to prevent damage to health.
Orthopedic shoesShoes that have a Goodyear welt, steel shank and elongated medial counter which are modified to compensate for an abnormality of the feet.
Shoe insertA device that is constructed of plexiglass, hard plastic or other rigid material fashioned for the individual feet by a laboratory approved to participate in the MA Program, and is fabricated according to a podiatrists prescription.
The provisions of this § 1143.2 adopted August 27, 1982, effective August 28, 1982, 12 Pa.B. 2855; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932. Immediately preceding text appears at serial pages (75087) to (75088).
This section cited in 55 Pa. Code § 1143.58 (relating to noncompensable services and items).
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