34 Pa. Code § 127.123
Payments to providers of home health care who file an HCFA Form 1728 (freestanding facilities) or an HCFA Form 2552 (hospital-based facilities), or any successor forms, shall be calculated as follows: the per visit limitation as determined by the Medicare Program multiplied by 113%. If the usual and customary charge per visit is lower than this calculation, then payment shall be limited to the usual and customary charge per visit. Payment at 113% of the Medicare limit shall represent payment for the entire service including all medical supplies and other items subject to cost reimbursement by the Medicare Program.
34 Pa. Code § 127.123
This section cited in 34 Pa. Code § 127.101 (relating to medical fee caps-Medicare); 34 Pa. Code § 127.157 (relating to medical fee updates on and after January 1, 1995-home health care providers).