55 Pa. Code § 1147.53 - Limitations on payment

(a) A vision examination is compensable only at the fee established in the MA Program fee schedule regardless of whether the optional components described in § 1147.2 (relating to definitions) are provided.

(b) Eyeglasses are limited to one full pair or two lenses per year. These are compensable only for eligible recipients who have received prior authorization from the Department or are receiving the eyeglasses under the EPSDT program or the School Medical program as described in Chapter 1101 (relating to general provisions).

(c) Low vision aids are limited to one per recipient per 2 years.

(d) Eye prostheses are limited to one per recipient per 2 years. These are compensable only for categorically needy recipients.

(e) Contact lenses are only compensable when used as a prostheses, such as, to replace the lens of the eye.

(f) Optometric services are compensable when provided in a clinic. The clinic is considered the provider and is responsible for billing the Department for services as defined in § 1221.51(5) (relating to general payment policy).

Notes

55 Pa. Code § 1147.53

The provisions of this § 1147.53 adopted January 25, 1980, effective 2/1/1980, 10 Pa.B. 264; amended May 22, 1981, effective 5/23/1981, 11 Pa.B. 1805; amended December 23, 1983, effective 1/1/1983, 13 Pa.B. 3932; amended November 30, 1984, effective 12/1/1984, 14 Pa.B. 4370, and by approval of the court of a joint motion for modification of a consent agreement dated February 11, 1985 in Turner v. Beal et al., C.A. No. 74-1680 (E. D. Pa. 1975); amended September 30, 1988, effective 10/1/1988, 18 Pa.B. 4418; amended August 3, 1990, effective immediately and apply retroactively to April 7, 1990, 20 Pa.B. 4196.

The provisions of this § 1147.53 issued under sections 403(a) and (b) and 443.6 of the Public Welfare Code (62 P. S. §§ 403(a) and (b) and 443.6).

This section cited in 55 Pa. Code § 1147.12 (relating to outpatient services); 55 Pa. Code § 1147.13 (relating to inpatient services); and 55 Pa. Code § 1147.51 (relating to general payment policy).