Section 1144.53. Noncompensable services

Latest version.

Payment will not be made for the following:
(1) Procedures not listed in the MA Program fee schedule or precluded by Chapter 1150 (relating to the MA Program payment policies).
(2) Services and procedures furnished by the CRNP for which payment is made to an enrolled medical service provider or practitioner.
(3) 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)).
(4) The same service and procedure furnished to the same recipient by a CRNP and physician, with whom the CRNP has protocols, on the same day.

                    
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