Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 8238 (December 30, 2023).

55 Pa. Code § 1243.54. Noncompensable services.

§ 1243.54. Noncompensable services.

 Payment will not be made to a laboratory for the following services regardless of where or to whom they are provided:

   (1)  Procedures not listed in the fee schedule in the MA Program fees schedule.

   (2)  Travel to a recipient’s place of residence to collect a specimen. The provider will be reimbursed for performing the procedure if it is compensable; however, no extra payment will be made for mileage.

   (3)  Procedures that the laboratory is not CLIA-certified to perform.


   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 §  1243.54 adopted December 5, 1980, effective December 1, 1980, 10 Pa.B. 4614; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932; amended September 30, 1988, effective October 1, 1988, 18 Pa.B. 4418; amended September 5, 2008, effective September 6, 2008, 38 Pa.B. 4898. Immediately preceding text appears at serial page (276180).

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