DEPARTMENT OF
PUBLIC WELFAREMedical Assistance Program Fee Schedule Revisions; Deletion of Codes Having Zero Occurrences [32 Pa.B. 5809] The Department of Public Welfare (Department) announces that effective December 1, 2002, changes will be made to the Medical Assistance (MA) Program Fee Schedule to begin to bring the procedure coding system into compliance with Health Insurance Portability and Accountability Act (HIPAA) (Pub. L. No. 104-191, 110 Stat. 1836) requirements. HIPAA requires payors of medical services to use standardized procedure code sets. The HIPAA procedure code sets that have been adopted are:
* National Drug Codes (NDC)--Drugs, biologicals.
* Current Dental Terminology, third edition (CDT-3)--Dental services.
* Current Procedure Terminology, fourth revision (CPT-4)--Physicians and all other services.
* CPT-4--HCFA Common Procedure Coding System (HCPCS) Level II--Medical equipment, injectible drugs, transportation services and other services not found in CPT-4.
The following provides those procedure codes that will be end dated November 30, 2002, due to zero occurrences during 2001.
Contact Person
A copy of this notice is available for review at local County Assistance Offices. Interested persons are invited to submit written comments to this notice within 30 days of this publication. Comments should be sent to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office, Attention: Regulations Coordinator, Room 515 Health and Welfare Building, Harrisburg, PA 17120. Comments received will be considered for future fee schedule revisions.
Persons with a disability may use the AT&T Relay Service, (800) 654-5984 (TDD users) or (800) 654-5988 (voice users). Persons who require another alternative should contact the Office of Legal Counsel, (717) 783-2209.
FEATHER O. HOUSTOUN,
SecretaryLocal Procedure Codes Being Deleted from the Fee Schedule as a Result of Zero Occurrences and which will not be Compensable for Services Provided after November 30, 2002 Procedure Type of Code Service Provider Type Description
W0090 AJ 01 EPSDT-Screen-Physician W0091 AJ 10 EPSDT-Screen-Independent clinic W0092 AJ 01 EPSDT-Screen-Basic hospital clinic W0093 AJ 11 EPSDT-Screen-Hospital outpatient clinic (enrollment approval required) W0095 AJ 49 EPSDT-Screen CRNPs W0190 HS 37 Hospice (drugs) W0191 HS 37 Respite (Medicare 1-5) W0192 HS 37 Respite (Medicare 6 or more) W0400 ES 50 Nonsecure psychiatric care W0401 ES 50 Secure psychiatric care W0519 AK 23 Exception to RN/LPN, PT, OT, ST audiologist limits W0526 AK 23 Audiological therapy (days 1-28) by an audiologist W0527 AK 23 Audiological therapy (29th day and beyond) by an audiologist W0609 HS 01 Attending physician direct care--general inpatient care--follow-up must be provided by physician not related to a hospice W0616 HS 01 Attending physician direct care-inpatient respite care--1-5 visits per 60 days--must be provided by physician not related to a hospice W0617 ES 50 Program exception--Case Management--Mental Health W0902 10 01 Declotting of internal A-V shunt anastomosis of graft with or without balloon catheter, artery or vein W0902 20 01 Declotting of internal A-V shunt anastomosis of graft with or without balloon catheter, artery or vein W0902 27 06, 08 Declotting of internal A-V shunt anastomosis of graft with or without balloon catheter, artery or vein W0902 40 01, 44 Declotting of internal A-V shunt anastomosis of graft with or without balloon catheter, artery or vein W0953 AK 23 Office visit hypodermic/intramuscular therapy W5947 30 09 Birth center visit, first trimester, physician W5948 30 09 Birth center visit, second trimester, physician W9078 CM 02 Case management research code (Initial case management services provided to a client) W9090 CM 02 Case management services/MA-0192 Waiver (Days 1-30) W9091 CM 02 Case management services/MA-0192 Waiver (Each 30 day period thereafter) W9250 80 01, 10, 11, 12 Rotational vestibular testing W9351 25 01, 11, 12 HIS bundle electrogram; with stress testing W9352 25 01, 11, 12 HIS bundle electrogram; with drug evaluation W9352 27 06, 08 HIS bundle electrogram; with drug evaluation W9353 25 01, 11, 12 HIS bundle electrogram; with tachyarrhythmia study W9356 25 01, 11, 12 Left cardiac catherization with insertion of transvenous electrode, temporary W9356 27 06, 08 Left cardiac catherization with insertion of transvenous electrode, temporary W9417 80 01, 10, 11, 12 Maximal expiratory volume studies W9417 AY 01 Maximal expiratory volume studies W9417 AZ 10, 11, 12 Maximal expiratory volume studies W9418 80 01, 10, 11, 12 Various forced expiratory volume studies, that is FEV1, FEV1%, FEV2, FEV3 W9418 AY 01 Various forced expiratory volume studies, that is FEV1, FEV1%, FEV2, FEV3 W9418 AZ 10, 11, 12 Various forced expiratory volume studies, that is FEV1, FEV1%, FEV2, FEV3 W9594 80 01, 08, 10, 11, 12 Electromyography; including nerve conduction velocities, four extremeties and related parasp. W9594 AY 01 Electromyography; including nerve conduction velocities, four extremeties and related parasp. W9594 AZ 08, 10, 11, 12 Electromyography; including nerve conduction velocities, four extremeties and related parasp. W9869 30 09 General assistance exception--obstetrical office visit W9874 AR 30 General assistance exception--family planning clinic W9875 30 01 General assistance exception--obstetrical office visit W9972 9P 05, 19 Patient vertical positioning device, nonmechanical X1165 20 01, 04, 10, 11, 12 Debridement of hypertrophic nail; subsequent, single X2135 27 06, 08 Treatment of closed or open fracture of malar area, including zygomatic arch and malar tripod w/o manipulation X2135 40 01, 44 Treatment of closed or open fracture of malar area, including zygomatic arch and malar tripod w/o manipulation X2825 20 01, 04, 10, 11, 12 Tenotomy and/or partial capsulotomy, closed, puncture or snap type, metatarsophalangeal joint X2825 27 06, 08 Tenotomy and/or partial capsulotomy, closed, puncture or snap type, metatarsophalangeal joint X2825 40 01, 44 Tenotomy and/or partial capsulotomy, closed, puncture or snap type, metatarsophalangeal joint X2835 20 01, 04, 10, 11, 12 Arthroplasty of foot; phalangeal-phalangeal joint X2835 27 06, 08 Arthroplasty of foot, phalangeal-phalangeal joint X2835 40 01, 44 Arthroplasty of foot, phalangeal-phalangeal joint X2836 10 01, 04 Arthroplasty of foot; first metatarsophalangeal joint, total joint replacement X2836 20 01, 04, 10, 11, 12 Arthroplasty of foot, first metatarsophalangeal joint, total joint replacement X2836 27 06, 08 Arthroplasty of foot, first metatarsophalangeal joint, total joint replacement X2836 40 01, 44 Arthroplasty of foot, first metatarsophalangeal joint, total joint replacement X2837 10 01, 04 Arthroplasty of foot; inter-phalangeal joint, with implant X2837 20 01, 04, 10, 11, 12 Arthroplasty of foot; inter-phalangeal joint, with implant X2837 27 06, 08 Arthroplasty of foot; inter-phalangeal joint, with implant X2837 40 01, 44 Arthroplasty of foot; inter-phalangeal joint, with implant X2838 10 01, 04 Arthroplasty of foot; metatarsal-phalangeal joint, with implant X2838 20 01, 04, 10, 11, 12 Arthroplasty of foot; metatarsal-phalangeal joint, with implant X2838 27 06, 08 Arthroplasty of foot; metatarsal-phalangeal joint, with implant X2838 40 01, 44 Arthroplasty of foot; metatarsal-phalangeal joint, with implant X3203 20 01, 11, 12 Thoracostomy tube with water seal, for drainage of malignant pleural effusion X3203 40 01, 04 Thoracostomy tube with water seal, for drainage of malignant pleural effusion X3553 10 01 Bypass graft, axillary-brachial X3553 20 01 Bypass graft, axillary-brachial X3553 27 06, 08 Bypass graft, axillary-brachial X3553 40 01, 44 Bypass graft, axillary-brachial X3626 25 01, 11, 12 Implantation of an infusion pump with catheterization hepatic artery by lararotomy X3626 40 01, 44 Implantation of an infusion pump with catheterization hepatic artery by lararotomy X3633 10 01 Percutaneous transluminal angioplasty; coronary artery (includes pre and post injections for angiography and cardiac catherization) X3633 20 01, 11, 12 Percutaneous transluminal angioplasty; coronary artery (includes pre and post injections for angiography and cardiac catherization) X3633 27 06, 08 Percutaneous transluminal angioplasty; coronary artery (includes pre and post injections for angiography and cardiac catherization) X3633 40 01, 44 Percutaneous transluminal angioplasty; coronary artery (includes pre and post injections for angiography and cardiac catherization) X3634 10 01 Catheterization of coronary artery with thrombolytic agent for recanalization (includes pre and post injections for angiography and cardiac catheterization) X3634 20 01, 11, 12 Cauterization of coronary artery with thrombolytic agent for recanalization (includes pre and post injections for angiography and cardiac catheterization) X3634 27 06, 08 Cauterization of coronary artery with thrombolytic agent for recanalization (includes pre and post injections for angiography and cardiac catheterization) X3634 40 01, 44 Cauterization of coronary artery with thrombolytic agent for recanalization (includes pre and post injections for angiography and cardiac catheterization) X3635 10 01 Percutaneous transluminal angioplasty; each additional vessel, eg, coronary, visceral, peripheral X3635 20 01, 11, 12 Percutaneous transluminal angioplasty; each additional vessel, eg, coronary, visceral, peripheral X3635 40 01, 44 Percutaneous transluminal angioplasty; each additional vessel, eg, coronary, visceral, peripheral X3659 10 01 Transluminal peripheral atherectomy, percutaneous; each additional vessel, eg, coronary, visceral and peripheral X3659 20 01 Transluminal peripheral atherectomy, percutaneous; each additional vessel, eg, coronary, visceral and peripheral X3659 40 01, 44 Transluminal peripheral atherectomy, percutaneous; each additional vessel, eg, coronary, visceral and peripheral X3823 10 01 Bone marrow harvesting for transplantation, autologous X3823 20 01 Bone marrow harvesting for transplantation, autologous X3823 40 01, 44 Bone marrow harvesting for transplantation, autologous X4320 25 01, 10, 11, 12 Suction esophageal biopsy X4320 40 01, 44 Suction esophageal biopsy X4530 25 01, 10, 11, 12 Proctosigmoidoscopy; routine service, asymptomatic patient X4530 40 01, 44 Proctosigmoidoscopy; routine service, asymptomatic patient X4533 25 01, 10, 11, 12 Sigmoidoscopy, flexible fiberoptic; asymptomatic patient X4533 40 01, 44 Sigmoidoscopy, flexible fiberoptic; asymptomatic patient X5812 10 01 Vaginal hysterectomy; with plastic repair of vagina, anterior and/or posterior colporrhaphy X5812 20 01 Vaginal hysterectomy; with plastic repair of vagina, anterior and/or posterior colporrhaphy X5812 40 01, 44 Vaginal hysterectomy; with plastic repair of vagina, anterior and/or posterior colporrhaphy X5888 20 01 Laparoscopy, with fulguration of oviducts and D&C (dilation and curettage) X5888 27 06, 08 Laparoscopy, with fulguration of oviducts and D&C (dilation and curettage) X5888 40 01, 44 Laparoscopy, with fulguration of oviducts and D&C (dilation and curettage) X5900 25 01 Percutaneous umbilical blood sampling (PUBS) X5902 25 01 Nipple stimulation stress test X5982 10 01 Abortion (elective); transabdominal approach X5982 30 01 Abortion (elective); transabdominal approach X5982 40 01, 44 Abortion (elective); transabdominal approach X6378 10 01 Subcutaneous implantation of infusion pump with catheterization for connection to intraspinal catheter (eg, epidural, intrathecal subarachnold) X6378 20 01 Subcutaneous implantation of infusion pump with catheterization for connection to intraspinal catheter (eg, epidural, intrathecal subarachnold) X6378 40 01, 44 Subcutaneous implantation of infusion pump with catheterization for connection to intraspinal catheter (eg, epidural, intrathecal subarachnold) X6680 20 01, 10, 11, 12 Discission of lens, needling of secondary membrane, complicated, as scissors X6680 27 06, 08 Discission of lens, needling of secondary membrane, complicated, as scissors X6680 40 01, 44 Discission of lens, needling of secondary membrane, complicated, as scissors Y0704 54 01, 08, 10, 11, 12 Arthrography, lumbar facet joint Y0704 57 01 Arthrography, lumbar facet joint Y0704 RD 08, 10, 11, 12 Arthrography, lumbar facet joint Y2600 10 01 HIP arthroscopy Y2600 20 01 HIP arthroscopy Y2600 27 06, 08 HIP arthroscopy Y2600 40 01, 44 HIP arthroscopy Y7033 54 01, 10, 11, 12 Magnetic resonance (eg, proton) imaging, temporomandibular joint; with contrast material Y7033 57 01 Magnetic resonance (eg, proton) imaging, temporomandibular joint; with contrast material Y7033 RD 08, 10, 11, 12 Magnetic resonance (eg, proton) imaging, temporomandibular joint; with contrast material Y7034 54 01, 10, 11, 12 Magnetic resonance (eg, proton) imaging, temporomandibular joint; without contrast material, followed by contrast material Y7034 57 01 Magnetic resonance (eg, proton) imaging, temporomandibular joint; without contrast material, followed by contrast material Y7034 RD 08, 10, 11, 12 Magnetic resonance (eg, proton) imaging, temporomandibular joint; without contrast material, followed by contrast material Y7210 54 01, 10, 11, 12 Radiology diagnostic, lumbar spine and pelvis; limited anteroposterior and lateral views of spine with anteroposterior view of pelvis Y7210 57 01 Radiology diagnostic, lumbar spine and pelvis; limited anteroposterior and lateral views of spine with anteroposterior view of pelvis Y7210 RD 08, 10, 11, 12 Radiology diagnostic, lumbar spine and pelvis; limited anteroposterior and lateral views of spine with anteroposterior view of pelvis Y7427 54 01, 10, 11, 12 Radiologic examination, colon; air contrast barium enema-asymptomatic patient Y7427 57 01 Radiologic examination, colon; air contrast barium enema-asymptomatic patient Y7427 RD 10, 11, 12 Radiologic examination, colon; air contrast barium enema-asymptomatic patient Y7540 54 01, 08, 10, 11, 12 Angiography, digital subtraction; simple (maximum 2 runs) Y7540 57 01 Angiography, digital subtraction; simple (maximum 2 runs) Y7540 RD 08, 10, 11, 12 Angiography, digital subtraction; simple (maximum 2 runs) Y7541 54 01, 08, 10, 11, 12 Angiography, digital, subtraction; intermediate (maximum 4 runs) Y7541 57 01 Angiography, digital, subtraction; intermediate (maximum 4 runs) Y7541 RD 08, 10, 11, 12 Angiography, digital, subtraction; intermediate (maximum 4 runs) Y7542 54 01, 08, 10, 11, 12 Angiography, digital subtraction; complex (more than 4 runs) Y7542 57 01 Angiography, digital subtraction; complex (more than 4 runs) Y7542 RD 08, 10, 11, 12 Angiography, digital subtraction; complex (more than 4 runs) Y7556 54 01, 10, 11, 12 Magnetic resonance (eg, proton) imaging, myocardium; without contrast material, followed by contrast material Y7556 57 01 Magnetic resonance (eg, proton) imaging, myocardium; without contrast material, followed by contrast material Y7556 RD 10, 11, 12 Magnetic resonance (eg, proton) imaging, myocardium; without contrast material, followed by contrast material Y7640 54 01, 10, 11, 12 Magnetic resonance (eg, proton) imaging, bone marrow blood supply; with contrast material Y7640 57 01 Magnetic resonance (eg, proton) imaging, bone marrow blood supply; with contrast material Y7640 RD 10, 11, 12 Magnetic resonance (eg, proton) imaging, bone marrow blood supply; with contrast material Y7641 54 01, 10, 11, 12 Magnetic resonance (eg, proton) imaging, bone marrow blood supply; without contrast material, followed by contrast material Y7641 57 01 Magnetic resonance (eg, proton) imaging, bone marrow blood supply; without contrast material, followed by contrast material Y7641 RD 10, 11, 12 Magnetic resonance (eg, proton) imaging, bone marrow blood supply; without contrast material, followed by contrast material Y7694 57 01 Ultrasonic guidance for percutaneous umbilical blood sampling (PUBS); supervision and interpretation only Y7695 54 01, 08, 10, 11, 12 Ultrasonic guidance for percutaneous umbilical blood sampling (PUBS); complete procedure Y7770 50 01, 11 Radioisotope dosimetry and interpretation of application Y7770 51 01 Radioisotope dosimetry and interpretation of application Y7770 RT 11 Radioisotope dosimetry and interpretation of application Y9653 AE 05, 19 Central venous catheter repair kit Y9936 AE 05, 19 Airway pressure manometer Z0042 9R 05, 19 Stationary compressed gas system rental, includes contents (per unit), regulator with flow gauge, humidifier, nebulizer, cannula or mask and tubing, 1 unit=50 cubic feet (less than 1 lpm) Z0131 9P 05, 19 Walk aid-rigid with balance ring Z0131 9R 05, 19 Walk aid-rigid with balance ring Z0132 9P 05, 19 Walk aid-Walkamatic (reciprocal) Z0462 9P 05, 19 Regulator (replacement) Z0519 9P 05, 19 Jar and lid (replacement accessory-volume ventilator portable) Z0542 9P 05, 19 Supporting grid (accessory-negative pressure) Z0543 9P 05, 19 Backplate (accessory-negative pressure) Z0545 9P 05, 19 Hose for chest shell or pullover (accessory-negative pressure) Z0546 9P 05, 19 Pneumobelt (accessory-volume ventilator) Z0547 9P 05, 19 Bladder (accessory-volume ventilator) Z0548 9P 05, 19 Pneumobelt hose to ventilator (accessory-volume ventilator) Z0882 9P 05, 19 Buck's extension with weights Z0883 9P 05, 19 Weights for traction set-up to 25 lbs (water) Z0937 9P 05, 19 Wrist device (dynasplint) Z0937 9R 05, 19 Wrist device (dynasplint) Z1000 9P 05, 19 Semi-pneumatic caster and wheel assembly, each Z1405 9R 05, 19 Oxygen concentrator, manufacturer specified maximum flow greater than 5 liters per minute, at 85% or greater concentration (less than 1 lpm) Z1407 9P 05, 19 Transtracheal catheter with cleaning rod Z1409 9P 05, 19 Transtracheal cleaning rods (replacement) Z1410 9P 05, 19 Transtracheal catheter wire guide Z1411 9P 05, 19 Transtracheal bead chain necklace Z1412 9R 05, 19 Oxygen and water vapor enriching system with heated delivery (less than 1 lpm) Z1413 9R 05, 19 Oxygen and water vapor enriching system with heated delivery (more than 4 lpm) Z1414 9R 05, 19 Oxygen and water vapor enrighing system without heated delivery (less than 1 lpm) Z1415 9R 05, 19 Oxygen and water vapor enriching system without heated delivery (more than 4 lpm) Z1605 AM 05, 19 Hip orthosis, ponsetta bar, knee pad Z1640 AM 05, 19 Hip orthosis, unilateral, pelvic band and belt, hip joint trochanter bar, thigh band and cuff for abduction Z2121 AM 05, 19 Ankle foot orthosis, tibial (Sarmiento, removable orthoplast) Z3061 AM 05, 19 Arch support, metal, each Z3987 AM 05, 19 Humeral orthosis, forearm and humeral orthoplast free motion elbow joints (removable) Z3988 AM 05, 19 Humeral orthosis, forearm and humeral orthoplast free motion elbow joints (removable) Z5231 9S 05, 19 Above knee prosthesis, modular quadrilateral plastic total contact with hip joint, single axis Z5241 9S 05, 19 Patellar tendon bearing prosthesis, modular plastic socket, soft closed end insert socket liner, each foot, cuff suspension, foam cover Z5243 9S 05, 19 Supracondylar patellar tendon bearing prosthesis, plastic socket, soft closed end insert socket linen or condylar wedge, each foot Z5244 9S 05, 19 Supracondylar patellar tendon bearing prosthesis, modular plastic socket, soft insert or hard socket or condylar wedge, foam cover and each foot Z6003 9B 05, 11 Factor-VIII, dry heat; per 100 international units Z6005 9B 05, 11 Cryoprecipitate, double bag Z6101 9S 05, 19 Below elbow prosthesis, wrist disarticulation, plastic socket, friction manual wrist unit Z6102 9S 05, 19 Below elbow prosthesis, plastic double wall socket, single pivot joints, friction manual wrist unit, below elbow figure-eight or ring single control flexible hinges and triceps pad Z6866 9S 05, 19 Cosmetic partial hand appliance with glove (zipper or no zipper) Z7606 9S 05, 19 Above elbow ring harness (including fitting) Z9009 AE 05, 19, 23 Pediatric tracheostomy metal swivel Z9888 ES 50 Medical case management [Pa.B. Doc. No. 02-2105. Filed for public inspection November 22, 2002, 9:00 a.m.]
