Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1241 - EARLY AND PERIODIC SCREENING, DIAGNOSIS AND TREATMENT PROGRAM
PAYMENT FOR EPSDT SCREENING
Section 1241.54 - Noncompensable services and items
Universal Citation: 55 PA Code ยง 1241.54
Current through Register Vol. 54, No. 44, November 2, 2024
(a) Payment will not be made for the following:
(1) Screens that do not include
the appropriate tests in Appendix A (relating to screening services required
examinations and diagnostic tests).
(2) General health care provided during an
EPSDT screening examination visit.
(3) A medical examination performed on the
same day as the screen.
(4)
Invoices not submitted to the billing contractor within 30 days of the
screening examination. Invoices received after 30 days will be
returned.
(5) Laboratory tests that
are included in the screening fee.
(b) The following services and items are noncompensable for medically needy screened individuals:
(1) Medical equipment and supplies, with the
exception of hearing aids and eyeglasses.
(2) Prostheses.
(3) Appliances.
(4) Orthoses.
(5) Pharmaceutical services as specified in
Chapter 1121 (relating to pharmaceutical services).
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