Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1143 - PODIATRISTS' SERVICES
GENERAL PROVISIONS
Section 1143.2 - Definitions

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

Chronic condition-An illness which frequently recurs or persists for a period in excess of 3 months.

Compensable service-A benefit to which a MA recipient is entitled under the MA Program.

Consultation-A medical evaluation conducted by a specialist at the request of the attending practitioner. For the purposes of the MA Program, a consultation includes taking a medical history, examining the patient, and preparing a written report that is incorporated into the patient's record.

Experimental procedure-A procedure that deviates from customary standards of medical practice, is not routinely used in the medical or surgical treatment of a specific illness or condition, or is not of proven medical value.

Medical justification-Written documentation in the patient's medical record indicating the specific health condition or risk that makes the particular service the podiatrist renders, orders or prescribes medically necessary.

Medically necessary-A term used to describe those medical conditions for which treatment is necessary, as determined by the Department, and which are compensable under the MA Program.

Molded shoes-Shoes that are constructed from a special last conforming to a specific individual's feet. Molded shoes are constructed from leather or other durable material.

Noncompensable service-A service a provider furnishes for which there is no provision for payment under this chapter.

Nonemergency medical services-A compensable podiatrists' service provided for conditions not requiring immediate medical intervention in order to sustain the life of the person or to prevent damage to health.

Orthopedic shoes-Shoes that have a Goodyear welt, steel shank and elongated medial counter which are modified to compensate for an abnormality of the feet.

Shoe insert-A device that is constructed of plexiglass, hard plastic or other rigid material fashioned for the individual feet by a laboratory approved to participate in the MA Program, and is fabricated according to a podiatrist's prescription.

This section cited in 55 Pa. Code § 1143.58 (relating to noncompensable services and items).