2411 Medical Assistance Program fee increase for dental behavior management; fee schedule procedure code changes; and fee increases for orthodontic and cleft palate services

Medical Assistance Program Fee Increase for Dental Behavior Management; Fee Schedule Procedure Code Changes; and Fee Increases for Orthodontic and Cleft Palate Services

[35 Pa.B. 7063]

   The Department of Public Welfare (Department) announces several changes to the Medical Assistance (MA) Program Fee Schedule. The changes include a fee increase for dental behavior management and for orthodontic and cleft palate services; the end-dating of local procedure codes for orthodontic and cleft palate services; and the addition of National procedure codes for orthodontic and cleft palate services. The changes are effective January 1, 2006, or February 1, 2006, specified as follows.

Fee Schedule Revisions

   The Department is increasing the MA fee for procedure code D9920, Behavior Management, from $78 to $125. This change is being made as part of the Department's continuing commitment to support the increased utilization of dental services by persons with disabilities. The Department is also increasing the MA fees for orthodontic and cleft palate services, set forth as follows, to support continued access to medically necessary orthodontic services. The fee increases are effective for dates of service on and after January 1, 2006.

   In addition, the Department is end-dating the following local procedure codes for orthodontic and cleft palate services and replacing them with the following National procedure codes, which are being added to the MA Program Fee Schedule, effective for dates of service on and after January 1, 2006.

Current   Code	New National    Code	Description of Service	Current Fee	Fee Effective January 1, 2006
D8900	D8660	Preorthodontic treatment visit	$20	$35
Z8052	D8080	Comprehensive orthodontic treatment of adolescent dentition    (includes first periodic orthodontic treatment visit)	$360	$600
Z8053 Z8054 Z8055 Z8056 Z8057 Z8058 Z8059	D8670	Periodic orthodontic treatment visit (as part of contract)	$160	$250
Z8310	D8680	Orthodontic retention (removal of appliances, construction    and placement of retainers	$50	$150
X7503	D0160	Detailed and extensive oral evaluation	$80	$120
X7504	D0170	Reevaluation	$15	$25
Z8051	D8999	Unspecified orthodontic procedure--one time payment	$63	*
* Authorization for services for which National procedure code D8999 will be used must be requested through the program exception process authorized in 55 Pa. Code § 1150.63 (relating to waivers). The fee for that code will be determined when the services are authorized.

   The local procedure codes for these services will not be compensable for services provided after December 31, 2005.

   The Department is also end-dating the following local procedure codes for cleft palate services and replacing them with the following National procedure codes, which are being added to the MA Program Fee Schedule, effective for dates of service on and after February 1, 2006.

Current   Code	New National    Code	Description of Service	Current Fee	Fee Effective January 1, 2006
X7500	D8080	Comprehensive orthodontic treatment of adolescent dentition    (includes first periodic orthodontic treatment visit)	$360	$600
X7501	D8670	Periodic orthodontic treatment visit (as part of contract)	$160	$250
X7502	D8680	Orthodontic retention (removal of appliances, construction    and placement of retainers)	$50	$150

   The local procedure codes for these services will not be compensable for services provided after January 31, 2006.

   Several of the new National procedure codes will be subject to prior authorization, as authorized by 62 P. S. § 443.6(b)(5) (relating to reimbursement for certain medical assistance items and services). The Department will issue a Medical Assistance Bulletin to all dental providers before the effective date of the changes, which will identify the specific procedure codes that require prior authorization.

Fiscal Impact

   These changes will result in increased costs of $1.196 million ($0.539 million in State funds) in the MA Outpatient Program in Fiscal Year 2005-2006 and $3.588 million ($1.631 million in State funds) in Fiscal Year 2006-2007.

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 Regu-lations Coordinator, Room 515, Health and Welfare Build-ing, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revision to the fee schedule.

   Persons with a disability who require an 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-459. (1) General Fund; (2) Implementing Year 2005-06 is $539,000; (3) 1st Succeeding Year 2006-07 is $1.631 million; 2nd Succeeding Year 2007-08 is $1.631 million; 3rd Succeeding Year 2008-09 is $1.631 million; 4th Succeeding Year 2009-10 is $1.631 million; 5th Succeeding Year 2010-11 is $1.631 million; (4) 2004-05 Program--$842,991; 2003-04 Program--$727,979; 2002-03 Program--$666,832; (7) Medical Assistance--Outpatient; (8) recommends adoption. Funds have been included in the Department's budget to cover this increase.

[Pa.B. Doc. No. 05-2411. Filed for public inspection December 30, 2005, 9:00 a.m.]