156 Medical Assistance program fee schedule procedure code changes for certified registered nurse practitioner,physician, podiatrist and hospice services

Medical Assistance Program Fee Schedule Procedure Code Changes for Certified Registered Nurse Practitioner, Physician, Podiatrist and Hospice Services

[36 Pa.B. 451]

   The Department of Public Welfare (Department) announces several changes to the Medical Assistance (MA) Program Fee Schedule for services provided by certified registered nurse practitioners, physicians, podiatrists and hospices, effective for dates of service on or after February 1, 2006.

Fee Schedule Revisions

   Local procedure codes W0165, W0171 and W0608 are being end-dated and will not be replaced with National procedure codes because there have been no claims submitted using these procedure codes since January 1, 2003.

   The SU modifier associated with National procedure code 11720 is being end-dated because there have been no claims submitted using this procedure code and modifier combination since January 1, 2002.

   Local procedure code X1070 is being removed from the MA Program Fee Schedule and will not be replaced with a National procedure code. The regulation at 55 Pa. Code § 1150.51(h)(5) (relating to general payment policies) precludes a separate payment for the removal of sutures. The fee for surgical services includes the removal of sutures. See 55 Pa. Code § 1150.54(a)(4)(iii) and (b)(1)(ii) (relating to surgical services).

   The following local and National procedure codes are being end-dated for podiatrists as the regulation at 55 Pa. Code § 1143.58(a)(11) (relating to noncompensable services and items) precludes payment for physical therapy services provided by podiatrists under the MA Program. Some podiatrists have inappropriately been submitting claims using these procedure codes.

Procedure Code

97001
97002
97010
97012
97014
97016
97018
97020
97022
97024
97026
97028
97032
97033
97034
97035
97036
97112
97116
97124
97140
W9715

   The following local procedure codes are being end-dated and replaced with existing National procedure codes already on the MA Program Fee Schedule and the corresponding fees already on the MA Program Fee Schedule.

Procedure Code

W0160
W0607
X1101
X1102
X1166
X1167
X1172
X1177
X1720
X5741
X9630

   The following local procedure codes are being end-dated and replaced with new National procedure codes that the Department is adding to the MA Program Fee Schedule.

Local Procedure Code	National Procedure Code	Pricing Modifier	Informational Modifier	MA Fee
W0602	T2042			Provider Specific Rate
W0603	T2043			Provider Specific Rate
W0604	T2044			Provider Specific Rate
W0605	T2045			Provider Specific Rate
W0606	T2046			Provider Specific Rate
X1720	17004			$132.38

   Some of the National procedure code fees may be higher and some may be lower than the fees corresponding with the local procedure codes.

   Medical Assistance Bulletins will be issued to certified registered nurse practitioners, physicians, podiatrists and hospices setting forth the local procedure codes that are being end-dated and the National procedure codes that are replacing them.

   Services rendered on or after February 1, 2006, must be billed using the National procedure code and modifier, if appropriate.

Fiscal Impact

   The conversion from local to National procedure codes is anticipated to be budget neutral and therefore these changes will have no fiscal impact.

Public Comment

   Interested persons are invited to submit written comments regarding this notice the Department of Public Welfare, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revisions of the MA Program Fee Schedule.

   Persons with a disability who require auxiliary aid or service may submit comments using the AT&T Relay Services at [phone] (TDD users) or [phone] (voice users).

ESTELLE B. RICHMAN,   
Secretary

   Fiscal Note: 14-NOT-462. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 06-156. Filed for public inspection January 27, 2006, 9:00 a.m.]