2280 Medical Assistance program fee schedule procedure code changes for family planning clinic services

Medical Assistance Program Fee Schedule Procedure Code Changes for Family Planning Clinic Services

[35 Pa.B. 6711]

   The Department of Public Welfare (Department) announces several changes to the Medical Assistance (MA) Program Fee Schedule for family planning clinic services.

Fee Schedule Revisions

   Effective with dates of service on or after November 1, 2005, local procedure codes W1851, W6003, W9181, W9182, W9183, W9184, W9185, X5746, X5831, Z4561, Z9983, Z9984, Z9985, Z9997 and Z9999 are being end-dated. Except as set forth as follows, these local procedure codes are being replaced with National procedure codes.

   MA enrolled Medical Directors with fee assignments to family planning clinics may bill from the Drug Reference File using the 10-digit National Drug Codes for drugs or supplies associated with the following end-dated local procedure codes: W1851, X5831 Z4561, Z9994, Z9985, Z9997 and Z9999.

   Local procedure code W9181 defined as ''Family Planning Clinic Visit, Comprehensive Visit'' is being unbundled. Under the local procedure code, all services performed during the visit including hemoglobin and pregnancy laboratory testing, papanicolaou smear, urine dipstick and contraceptive dispensing were included in the payment. The National procedure code provides payment for the visit and not any additional services, drugs or supplies provided during the visit. The fee for the National procedure code is $20 per visit.

   Local procedure code W9182 defined as ''Family Planning Clinic Visit, Problem Visit'' is being unbundled. Under the local procedure code, all services performed during the visit including contraceptive dispensing were included in the payment. The National procedure code provides payment for the visit and not any additional services, drugs or supplies provided during the visit. The fee for the National procedure code is $20.

   Local procedure code W9184 defined as ''Family Planning Clinic Visit, Routine Revisit'' is being unbundled. Under the local procedure code, all services performed during the visit including pregnancy laboratory testing, papanicolaou smear, urine dipstick and contraceptive dispensing were included in the payment. The National procedure code provides payment for the visit and not any additional services, drugs or supplies provided during the visit. The fee for the National procedure code is $20.

   Local procedure code X5831 defined as ''Implantation of Contraceptives, Including Device (for example, Norplant)'' is being unbundled. Family planning clinics will bill the cross walked National procedure code at the MA Fee Schedule fee of $100 rather than the $500 fee associated with the local procedure code. The National procedure code only includes payment for the surgical procedure to implant the contraceptive device.

   Local procedure code W9185 defined as ''Women's Medical Service--Title XX'' should not be on the MA Program Fee Schedule as it is not a Title XIX service. Local procedure code X9185 is being end-dated and not cross walked to a National procedure code.

   Local procedure code Z9983 defined as ''Progestasert Intrauterine Device (IUD)'' is being end-dated and not cross walked to a National procedure code as the Progestasert IUD is no longer manufactured.

   The Department consulted with the Family Planning Councils prior to making these changes.

   A Medical Assistance Bulletin will be issued to family planning clinics setting forth the local procedure codes that are being end-dated and, if applicable, the National procedure codes that are replacing them.

   Services rendered on or before October 31, 2005, must be billed using the local procedure code. Services rendered on or after November 1, 2005, must be billed using the National procedure code or billed from the Drug Reference File.

Fiscal Impact

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

Public Comment

   Interested persons are invited to submit written comments regarding this notice to 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 in subsequent revisions to this notice.

   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-447. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 05-2280. Filed for public inspection December 9, 2005, 9:00 a.m.]