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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 § 1243.52. Payment conditions for various services.

§ 1243.52. Payment conditions for various services.

 (a)  If a laboratory refers work to another laboratory, payment will be made to either the referring laboratory or the laboratory actually performing the test. Payment will be made only if the laboratory billing the Department is currently participating in the MA Program and has listed the diagnostic procedure being billed with the Department as specified in §  1243.41(1) (relating to participation requirements).

 (b)  Laboratory procedures billed to the Department will be based on a written request of the practitioner. The written request must include the following:

   (1)  The name of the practitioner, the Medical Assistance Identification (M.A.I.D.) number of the practitioner or the DEA number of the practitioner.

   (2)  The name of the recipient.

   (3)  The case number of the recipient.

   (4)  The date of the request.

   (5)  The handwritten signature of the practitioner or the designee of the practitioner.

 (c)  Preadmission laboratory tests performed by a hospital laboratory shall be included in the inpatient billing of the hospital. If the recipient is not admitted for some reason, the preadmission laboratory tests shall be billed as an outpatient claim.


   The provisions of this section are amended under sections 201(2), 403 and 443.3 of the Public Welfare Code (62 P. S. § §  201(2), 403 and 443.3).


   The provisions of this §  1243.52 adopted December 5, 1980, effective December 1, 1980, 10 Pa.B. 4614; amended September 5, 2008, effective September 6, 2008, 38 Pa.B. 4898. Immediately preceding page appears at serial page (276179).

Cross References

   This section cited in 55 Pa. Code §  1243.52a (relating to clarification of the terms ‘‘written’’ and ‘‘signature’’—statement of policy).

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