Medical Assistance Program Fee Schedule Updates [46 Pa.B. 1097]
[Saturday, February 27, 2016]In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Human Services (Department) announces changes to the Medical Assistance (MA) Program Fee Schedule, effective for dates of service on and after March 1, 2016.
The Department is end-dating and adding procedure codes as a result of updates made by the Centers for Medicare and Medicaid Services (CMS) to the Healthcare Common Procedure Coding System.
Procedure Codes Being End-Dated or Added
The Department is end-dating procedure code G0154, defined as ''Direct skilled nursing services of a registered nurse (RN) or a licensed practical nurse (LPN) in the home health or hospice setting'' from the MA Program Fee Schedule effective with dates of service on and after March 1, 2016.
CMS designated replacement codes to differentiate the services of an RN from that of an LPN. The Department is adding procedure codes G0299 and G0300 to the MA Program Fee Schedule, effective with dates of service on and after March 1, 2016, as follows:
Procedure Code Procedure Code Description Provider Type Specialty Place of Service Pricing Modifier Info Modifier MA
FeeMA Units of Service Limits PA Required G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting. 05 050 12 U8 $88 Per Visit Unlimited visits first 28 days Yes G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting. 05 050 12 U8 UD $88 Per Visit Limited to 15 days per month after first 28 days Yes G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting. 01 183 22 U9 HD $74 45 minute visit One 45 minute visit per day No G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting. 05 050 12 U9 HD $74 45 minute visit One 45 minute visit per day No G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting. 08 080 12, 50 U9 HD $74 45 minute visit One 45 minute visit per day No G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting. 08 081 12, 72 U9 HD $74 45 minute visit One 45 minute visit per day No G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting. 08 082 49 U9 HD $74 45 minute visit One 45 minute visit per day No G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting. 08 083 22, 49 U9 HD $74 45 minute visit One 45 minute visit per day No G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting. 31 All 12 U9 HD $74 45 minute visit One 45 minute visit per day No G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting. 33 335 12 U9 HD $74 45 minute visit One 45 minute visit per day No G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting. 47 470 25 U9 HD $74 45 minute visit One 45 minute visit per day No G0300 Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting. 05 050 12 U8 $88 Per Visit Unlimited visits first 28 days Yes G0300 Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting. 05 050 12 U8 UD $88 Per Visit Limited to 15 days per month after first 28 days Yes Fiscal Impact
This change will have no fiscal impact on the Fee-for-Service appropriation.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, 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 the notice.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
THEODORE DALLAS,
SecretaryFiscal Note: 14-NOT-992. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 16-336. Filed for public inspection February 26, 2016, 9:00 a.m.]
