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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 2336 (April 27, 2024).

55 Pa. Code § 1241.54. Noncompensable services and items.

§ 1241.54. Noncompensable services and items.

 (a)  Payment will not be made for the following:

   (1)  Screens that do not include the appropriate tests in Appendix A (relating to screening services required examinations and diagnostic tests).

   (2)  General health care provided during an EPSDT screening examination visit.

   (3)  A medical examination performed on the same day as the screen.

   (4)  Invoices not submitted to the billing contractor within 30 days of the screening examination. Invoices received after 30 days will be returned.

   (5)  Laboratory tests that are included in the screening fee.

 (b)  The following services and items are noncompensable for medically needy screened individuals:

   (1)  Medical equipment and supplies, with the exception of hearing aids and eyeglasses.

   (2)  Prostheses.

   (3)  Appliances.

   (4)  Orthoses.

   (5)  Pharmaceutical services as specified in Chapter 1121 (relating to pharmaceutical services).


   The provisions of this §  1241.54 adopted December 6, 1980, effective December 1, 1980, 10 Pa.B. 4611.

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