Section 1142.55. Noncompensable services

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)).

The provisions of this § 1142.55 adopted October 8, 1982, effective October 9, 1982, 12 Pa.B. 3647; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932; amended October 1, 1988, 18 Pa.B. 4418. Immediately preceding text appears at serial pages (117370) to (117371).