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.

The provisions of this § 1143.2 adopted August 27, 1982, effective August 28, 1982, 12 Pa.B. 2855; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932. Immediately preceding text appears at serial pages (75087) to (75088).

Notation

Cross References

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