346 Medical Assistance program fee schedule procedure code changes

DEPARTMENT OF
PUBLIC WELFARE

Medical Assistance Program Fee Schedule Procedure Code Changes

[36 Pa.B. 1016]

   The Department of Public Welfare (Department) announces several changes to the Medical Assistance (MA) Program Fee Schedule, effective for dates of services on or after March 1, 2006.

Fee Schedule Revisions

   Local procedure code W9562 is being end-dated and not replaced with a National procedure code because there have been no claims submitted using this procedure code since January 1, 2004.

   Local procedure code W9400 is being end-dated and not replaced with a National procedure code because there have been no claims submitted using this procedure code since January 1, 2004. In addition, the regulation at 55 Pa. Code § 1221.51(1) (relating to general payment policy) provides that the fee for a clinic visit includes the administration of drugs and biologicals.

   The 80 modifier associated with National procedure codes 57460 and 57461 is being end-dated because the prevailing standard of care is that these procedures do not require the services of an assistant surgeon.

   The following local procedure codes are being end-dated for Independent Medical-Surgical Clinics and replaced with existing National procedure codes already on the MA Program Fee Schedule and the fees corresponding with the National procedure codes. Some of the fees for the existing National procedure codes may be higher and some may be lower than the fees corresponding with the local procedure codes.

Procedure Code

W0644
W0660
W0661
W0662
W9067
W9416
W9564
W9630
W9633
W9635
W9640
W9715
W9871
X1101
X1102
X1166
X1167
X1172
X1177
X1720
X5741
X5746
Y7030
Y7100
Y7101
Y7200
Y7202
Y7211
Y7308
Y7310
Y7311
Y7312
Y7324
Y7360

   The Department is adding the following National procedure codes to the MA Program Fee Schedule. These National procedure codes are replacing the specific end-dated local procedure codes set forth as follows:

National Procedure Code	Pricing Modifier	Informational Modifier	MA Fee	Local Procedure Code
P9021			$30.00	W6013
P9019			$30.00	W6014
76001			$27.50	Y7600
76001	26		$11.00	Y7600
76001	TC		$16.50	Y7600

   A Medical Assistance Bulletin will be issued to independent medical-surgical clinics setting forth the National procedure codes and corresponding fees that are replacing the end-dated local procedure codes.

   Services rendered on or after March 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 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 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-466. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 06-346. Filed for public inspection February 24, 2006, 9:00 a.m.]