Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1128 - RENAL DIALYSIS SERVICES
PAYMENT FOR RENAL DIALYSIS SERVICES
Section 1128.54 - Noncompensable services and items
Current through Register Vol. 54, No. 12, March 23, 2024
The Department does not pay dialysis facilities for:
(1) Services that do not conform to this chapter.
(2) Services provided by a dialysis facility that does not meet the Federal Medicare requirements at 42 CFR 405.2100 (relating to scope of subpart).
(3) Services and items to the extent that payment is available through Medicare, other health insurance programs or financial resources.
(4) Diagnostic or therapeutic procedures solely for experimental, research or educational purposes.
(5) Procedures that are not listed in the MA Program fee schedule.
(6) Services that are not medically necessary.
(7) Services provided to recipients who are hospital inpatients.