2412 Medical Assistance Program fee schedule changes

Medical Assistance Program Fee Schedule Changes

[35 Pa.B. 7065]

   The purpose of this notice is to announce corrections to the Medical Assistance (MA) Program Fee Schedule concerning four National procedure codes that were recently added to the MA Program Fee Schedule as a result of implementing the 2005 updates made by the Centers for Medicare and Medicaid Services to the Healthcare Common Procedure Coding System (HCPCS).

Fee Schedule Revisions

   The Department has determined that information relating to the following National procedure codes that were added to the MA Program Fee Schedule contained errors.

   The fees identified with National procedure codes E2611 and E2612 were incorrect. The fees for these procedures were reduced to reflect an appropriate payment to comply with the State Plan requirement that Pennsylvania Medicaid fees not exceed Medicare reimbursement fees. The correct fees are set forth as follows, effective for dates of service on and after February 1, 2006.

Code	Modifier	Terminology	Price on 2005 MAB	Correction
E2611	NU	General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware	$312.35	Price changed to $249.88
E2612	NU	General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware	$422.54	Price changed to $338.03

   The modifiers identified with National procedure codes 58565 and 97597 were incorrect. As set forth as follows, the following modifiers are being removed from the MA Program Fee Schedule, effective for dates of service on and after February 1, 2006.

Code	Modifier	Terminology	Correction
58565	80	Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants	Remove 80 modifier
97597	SG	Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or equal to 20 square centimeters	Remove SG modifier

   A Medical Assistance Bulletin will be issued to all providers correcting MA Bulletin 99-05-15, ''2005 HCPCS Updates and Other Revisions to the Medical Assistance Fee Schedule; Prior Authorization Requirements,'' which was issued September 12, 2005.

Fiscal Impact

   The fiscal impact of the changes related to the 2005 HCPCS updates was provided in a previous fiscal note, and the related costs are provided for in the MA-Outpatient Program budget. The corrections are anticipated to result in minimal savings in the Outpatient Program.

Public Comment

   Interested persons are invited to submit written comments regarding this notice to 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 revision of this notice.

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

ESTELLE B. RICHMAN,   
Secretary

   Fiscal Note: 14-NOT-455. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 05-2412. Filed for public inspection December 30, 2005, 9:00 a.m.]