Current through Register Vol. 54, No. 24, June 15, 2024
Section 1123.54 - Orthopedic shoes, molded shoes and shoe insertsPayment for orthopedic shoes, molded shoes and shoe inserts prescribed for eligible persons is paid to approved Medical Assistance providers in accordance with the limitations described in this section and the maximum fees listed in Chapter 1150 (relating to Medical Assistance program payment policies) and the Medical Assistance program fee schedule.
(1) Prior approval shall be obtained from the Department for orthopedic shoes, molded shoes and shoe inserts.(2) Payment for molded shoes is made only for those shoes prescribed for severe foot and ankle conditions and deformities of a degree that the patient is unable to wear ordinary sturdy shoes with or without corrections and modifications.(3) Payment for modifications to orthopedic shoes and molded shoes will be made only if those modifications are necessary for the application of a brace or splint.(4) Payment for repairs to orthopedic and molded shoes is made un-der the Medical Assistance program without a prescription or prior authorization.(5) Payment for orthopedic shoes is made only if the recipient is 20 years of age or younger.The provisions of this § 1123.54 adopted May 9, 1980, effective 7/1/1980, 10 Pa.B. 1882; amended September 26, 1980, effective 10/1/1980, 10 Pa.B. 3796; 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. This section cited in 55 Pa. Code § 1123.52 (relating to payment conditions for various services).