Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1123 - MEDICAL SUPPLIES
PAYMENT FOR MEDICAL SUPPLIES
Section 1123.54 - Orthopedic shoes, molded shoes and shoe inserts
Current through Register Vol. 54, No. 12, March 23, 2024
Payment for orthopedic shoes, molded shoes and shoe inserts prescribed for eligible persons is paid to approved Medical Assistance providers in accordance with the limitations described in this section and the maximum fees listed in Chapter 1150 (relating to Medical Assistance program payment policies) and the Medical Assistance program fee schedule.
(1) Prior approval shall be obtained from the Department for orthopedic shoes, molded shoes and shoe inserts.
(2) Payment for molded shoes is made only for those shoes prescribed for severe foot and ankle conditions and deformities of a degree that the patient is unable to wear ordinary sturdy shoes with or without corrections and modifications.
(3) Payment for modifications to orthopedic shoes and molded shoes will be made only if those modifications are necessary for the application of a brace or splint.
(4) Payment for repairs to orthopedic and molded shoes is made un-der the Medical Assistance program without a prescription or prior authorization.
(5) Payment for orthopedic shoes is made only if the recipient is 20 years of age or younger.
This section cited in 55 Pa. Code § 1123.52 (relating to payment conditions for various services).
