Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

• No statutes or acts will be found at this website.

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

55 Pa. Code § 1144.53. Noncompensable services.

§ 1144.53. Noncompensable services.

 Payment will not be made for the following:

   (1)  Procedures not listed in the MA Program fee schedule or precluded by Chapter 1150 (relating to the MA Program payment policies).

   (2)  Services and procedures furnished by the CRNP for which payment is made to an enrolled medical service provider or practitioner.

   (3)  Services and procedures for which payment is available through other public agencies or private insurance plans as described in §  1101.64 (relating to third-party medical resources (TPR)).

   (4)  The same service and procedure furnished to the same recipient by a CRNP and physician, with whom the CRNP has protocols, on the same day.



No part of the information on this site may be reproduced for profit or sold for profit.


This material has been drawn directly from the official Pennsylvania Code full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.