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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 § 1144.52. Payment conditions.

§ 1144.52. Payment conditions.

 Payment will be made to a CRNP for services furnished if the following conditions are met:

   (1)  The CRNP, unless qualifying for the exception in paragraph (3), does not have a financial arrangement to provide the services as an employe of or is not under contract to an enrolled medical service provider or practitioner.

   (2)  The services billed to the Department are furnished by the CRNP in collaboration with and under the direction of a physician licensed to practice medicine in this Commonwealth.

   (3)  An exception to the payment condition in paragraph (1) has been established for the CRNP employed by an enrolled MA entity unable to be reimbursed for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) screens. In this case, the CRNP may enroll with the Department, with the employer recognized as the payee.

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