55 Pa. Code § 1149.51 - General payment policy

Payment for dentists' services is subject to the conditions and limitations set forth in this chapter and Chapters 1101 and 1150 (relating to general provisions; and MA Program payment policies) and the MA Program fee schedule. The following payment policies are applicable for dental services:

(1) The amount paid for dental services is the dentist's usual charge to the general public or the fees listed in MA Program fee schedule, whichever is less.

(2) Payment is made for the services or items listed in the amounts specified in the MA Program fee schedule on behalf of a person no longer eligible for MA, provided the person was an eligible MA recipient at the time the ser-vice was initiated and the invoice for payment is submitted within 180 days after the service was initiated.

Notes

55 Pa. Code § 1149.51

The provisions of this § 1149.51 adopted January 25, 1985, effective 1/15/1985, 15 Pa.B. 255; amended September 30, 1988, effective 10/1/1988, 18 Pa.B. 4418.