Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1142 - MIDWIVES' SERVICES
PAYMENT FOR MIDWIVES' SERVICES
Section 1142.55 - Noncompensable services

Universal Citation: 55 PA Code ยง 1142.55

Current through Register Vol. 54, No. 44, November 2, 2024

Payment will not be made for:

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

(2) More than 12 midwife visits per recipient per 365 days (this includes prenatal and postpartum visits). One postpartum visit is included in the delivery fee and is not considered when computing the maximum of 12 visits.

(3) Services and procedures furnished by the midwife for which payment is made to an enrolled physician, rural health clinic, hospital or independent medical clinic.

(4) 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)).

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