518 Medical Assistance Program fee schedule increases for select chemotherapy administration procedure codes
Medical Assistance Program Fee Schedule Increases for Select Chemotherapy Administration Procedure Codes [38 Pa.B. 1407]
[Saturday, March 22, 2008]The Department of Public Welfare (Department) announces that it will increase the fees paid by the Medical Assistance (MA) Program for select chemotherapy administration procedure codes effective with dates of service on or after March 22, 2008. The Department consulted with the Pennsylvania Medical Society, medical providers, and other key stakeholders in determining which existing fees for select chemotherapy administration procedure codes should be increased to support continued access to medical services by MA recipients. The Department is increasing the fees for the following chemotherapy administration procedure codes.
National Code Procedure Description Current Fee Fee Effective
March 1, 200836640 Arterial catheterization for prolonged infusion therapy (chemotherapy), cutdown $73.50 $93.50 51720 Bladder instillation of anticarcinogenic agent (including retention time) $26.00 $66.94 95990 Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular) $41.87 $47.46 96401 Chemotherapy administration, subcutaneous or intramuscular; nonhormonal antineoplastic $38.61 $50.23 96402 Chemotherapy administration, subcutaneous or intramuscular; hormonal antineoplastic $27.35 $31.76 96409 Chemotherapy administration; intravenous, push technique, single or initial substance/drug $69.98 $92.20 96411 Chemotherapy administration; intravenous, push technique, each additional substance/drug (List separately in addition to code for primary procedure.) $43.82 $52.89 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug $99.53 $124.80 96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure.) $26.63 $28.28 96416 Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump $124.96 $135.16 96417 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure.) $59.65 $61.68 96420 Chemotherapy administration, intra-arterial; push technique $32.00 $86.78 96422 Chemotherapy administration, intra-arterial; infusion technique, up to 1 hour $32.00 $143.57 96423 Chemotherapy administration, intra-arterial; infusion technique, each additional hour (List separately in addition to code for primary procedure.) $32.00 $62.16 96425 Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump $37.01 $140.94 96440 Chemotherapy administration into pleural cavity, requiring and including thoracentesis $74.00 $103.75 96445 Chemotherapy administration into peritoneal cavity, requiring and including peritoneocentesis $74.00 $97.21 96450 Chemotherapy administration, into CNS (such as, intrathecal), requiring and including spinal puncture $28.00 $76.66 96521 Refilling and maintenance of portable pump $91.55 $108.81 96522 Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (such as, intravenous, intra-arterial) $64.75 $86.85 96542 Chemotherapy injection, subarachnoid or intraventricular my means of subcutaneous reservoir, single or multiple agents $22.00 $37.43 Fiscal Impact
These changes will result in the increased costs of $0.024 million ($0.011 million in State funds) in the Medical Assistance--Outpatient Program in Fiscal Year 2007-2008, and $0.147 million ($0.068 million in State funds) in Fiscal Year 2008-2009.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department at the following address: 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 any subsequent revisions to the MA Program Outpatient Fee Schedule.
Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Services at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-545. (1) General Fund; (2) Implementing Year 2007-08 is $11,000; (3) 1st Succeeding Year 2008-09 is $68,000; 2nd Succeeding Year 2009-10 is $68,000; 3rd Succeeding Year 2010-11 is $68,000; 4th Succeeding Year 2011-12 is $68,000; 5th Succeeding Year 2012-13 is $68,000; (4) 2006-07 Program--$671,472,000; 2005-06 Program--$945,950,000; 2004-05 Program--$842,991,000; (7) Medical Assistance--Outpatient; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 08-518. Filed for public inspection March 21, 2008, 9:00 a.m.]
