DEPARTMENT OF PUBLIC WELFARE Medical Assistance Program Fee Schedule Revisions; 1997 HCPCS Updates [27 Pa.B. 2201] By this notice, the Department of Public Welfare announces effective January 1, 1997 that changes have been made to the Medical Assistance Program Fee Schedule as a result of implementing the 1997 updates to the Health Care Financing Administration Common Procedure Coding System (HCPCS). The Federally required updates add new procedure codes which are compensable beginning January 1, 1997. The procedure codes being deleted from the fee schedule as a result of those updates will not be compensable for services provided after March 31, 1997.
Changes to the Medical Assistance Program Fee Schedule Effective May 1, 1997
for Provider Types 05, 19 and 23FEE CHANGES:
Type of Service Procedure Code Description MA Fee Change 9R E0570 Nebulizer with Compressor $72.82 $18.82 9R E0651 Pneumatic Compressor Segmental Home Model Without Calibrated Gradient Pressure $70.68 $70.69 9R K0005 Ultralight Wheelchair $162.47 $162.48 Additions Effective January 1, 1997
TOS Procedure Code Fee TOS Procedure Code Fee AE, 55 A6196 6.62 AE, 55 A6224 3.25 AE, 55 A6197 14.81 AE, 55 A6228 2.51 AE, 55 A6198 19.42 AE, 55 A6229 3.25 AE, 55 A6199 4.76 AE, 55 A6234 5.89 AE, 55 A6203 3.01 AE, 55 A6235 15.16 AE, 55 A6204 5.61 AE, 55 A6236 24.54 AE, 55 A6205 4.68 AE, 55 A6237 7.12 AE, 55 A6206 .99 AE, 55 A6238 20.53 AE, 55 A6207 6.61 AE, 55 A6239 18.70 AE, 55 A6209 6.75 AE, 55 A6240 11.03 AE, 55 A6210 17.94 AE, 55 A6241 2.31 AE, 55 A6211 26.46 AE, 55 A6242 5.47 AE, 55 A6212 8.74 AE, 55 A6243 11.10 AE, 55 A6213 11.60 AE, 55 A6244 35.38 AE, 55 A6214 9.27 AE, 55 A6245 6.54 AE, 55 A6216 .07 AE, 55 A6246 8.93 AE, 55 A6217 .39 AE, 55 A6247 21.42 AE, 55 A6218 .59 AE, 55 A6248 14.63 AE, 55 A6219 .86 AE, 55 A6251 1.80 AE, 55 A6220 2.32 AE, 55 A6252 2.93 AE, 55 A6221 3.63 AE, 55 A6253 5.72 AE, 55 A6222 1.91 AE, 55 A6254 1.07 AE, 55 A6223 2.17 AE, 55 A6255 2.73 AE, 55 A6256 1.53 AE, 55 A6402 .12 AE, 55 A6257 1.38 AE, 55 A6403 .40 AE, 55 A6258 3.87 AE, 55 A6405 .31 AE, 55 A6259 9.85 AE, 55 A6406 .74 AE, 55 A6266 1.73 9P K0268 99.28 AE, 55 K0419 15.93 AE, 55 K0428 8.93 AE, 55 K0420 44.14 AE, 55 K0429 4.73 AE, 55 K0421 3.98 AE, 55 K0430 6.24 AE, 55 K0422 28.53 AE, 55 K0431 3.73 AE, 55 K0423 13.94 AE, 55 K0432 4.05 AE, 55 K0424 34.63 AE, 55 K0433 5.77 AE, 55 K0425 4.28 AE, 55 K0434 8.92 AE, 55 K0426 22.84 AE, 55 K0435 6.56 AE, 55 K0427 26.16 AE, 55 K0436 6.17 AE, 55 K0437 8.51 AE, 55 L4390 107.39 AM, 55 L4396 114.15 AE, 55 K4392 16.01 AM, 55 L4398 52.55 AE, 55 K4394 11.68 End-dated March 31, 1997
TOS Procedure Code TOS Procedure Code TOS Procedure Code AE, 55 K0223 AE, 55 K0243 AE, 55 K0257 AE, 55 K0224 AE, 55 K0244 AE, 55 K0258 AE, 55 K0228 AE, 55 K0245 AE, 55 K0259 AE, 55 K0229 AE, 55 K0246 AE, 55 K0266 AE, 55 K0234 AE, 55 K0247 AE, 55 K0275 AE, 55 K0235 AE, 55 K0248 AE, 55 K0276 AE, 55 K0236 AE, 55 K0249 AE K0402 AE, 55 K0237 AE, 55 K0251 AE K0403 AE, 55 K0238 AE, 55 K0252 AE K0405 AE, 55 K0239 AE, 55 K0253 AE K0406 AE, 55 K0240 AE, 55 K0254 AE, 55 L4200 AE, 55 K0241 AE, 55 K0255 AE, 55 K0242 AE, 55 K0256 Changes to the Medical Assistance Program Fee Schedule for Provider Types 01, 03, 04, 10, 11, 12, 15, 16, 17, 20, 30, 43, 49 and 50:
Additions Effective January 1, 1997
TOS Procedure Code Fee TOS Procedure Code Fee 20 11010 340.00 20 24341 600.10 27 11010 776.00 27 24341 776.00 40 11010 136.00 40 24341 240.04 20 11011 405.24 20 26185 376.74 27 11011 776.00 27 26185 776.00 40 11011 162.10 40 26185 150.70 20 11012 563.23 10 26546 139.26 27 11012 776.00 20 26546 696.31 40 11012 225.29 27 26546 776.00 20 11720 20.00 40 26546 278.52 20 11721 20.00 10 15756 200.00 10 26551 200.00 20 15756 1000.00 20 26551 1000.00 27 15756 776.00 27 26551 776.00 40 15756 400.00 40 26551 400.00 10 15757 200.00 10 26553 200.00 20 15757 1000.00 20 26553 1000.00 27 15757 776.00 27 26553 776.00 40 15757 400.00 40 26553 400.00 10 15758 200.00 10 26554 200.00 20 15758 1000.00 20 26554 1000.00 27 15758 776.00 27 26554 776.00 40 15758 400.00 40 26554 400.00 10 20150 200.00 10 26556 200.00 20 20150 1000.00 20 26556 1000.00 27 20150 776.00 27 26556 776.00 40 20150 400.00 40 26556 400.00 10 20956 200.00 20 27036 982.42 20 20956 1000.00 27 27036 776.00 27 20956 776.00 40 27036 392.97 40 20956 400.00 20 49021 474.45 10 20957 200.00 27 49021 776.00 20 20957 1000.00 40 49021 189.78 27 20957 776.00 20 52301 364.49 40 20957 400.00 27 52301 776.00 10 24149 200.00 40 52301 145.80 20 24149 1000.00 10 61586 200.00 27 24149 776.00 20 61586 1000.00 40 24149 400.00 40 61586 400.00 10 24341 120.00 54 92978 245.12 80 93315 264.00 RD 92978 150.13 AZ 93316 126.81 57 92978 94.99 AY 93317 137.19 20 G0051 39.04 54 G0062 24.94 20 G0052 12.51 RD G0062 35.35 20 G0053 214.86 57 G0062 10.91 54 G0063 115.96 RD G0063 101.81 57 G0063 14.15 End-dated March 31, 1997
TOS Procedure Code TOS Procedure Code 86 Q0116 20, 27, 40 68800 20 11700 20, 27, 40 68820 20 11701 20, 27, 40 68825 10, 20, 27, 40 15755 20, 27, 40 68830 10, 20, 40 20960 80 93201 10, 20, 40 20971 80 93202 10, 20, 27, 40 25330 80 93204 10, 20, 40 25331 80 93205 10, 20, 40 26552 AY 93208 10, 20, 40 26557 AZ 93209 10, 20, 40 26558 80 93220 10, 20, 40 26559 AY 93221 10, 20, 27, 40 42880 AZ 93222 20, 40 53640 80, AY, AZ 94160 10, 20, 27, 40 56360 60, PT 97500 10, 25, 27, 40 56361 60, ED, RT 97501 60, ED, RT 97521 The fiscal note was prepared under provision of section 612 of The Administrative Code of 1929 (71 P. S. § 232).
Price changes made to the Medical Assistance Fee Schedule are routinely included in carryforward budget estimates.
Contact Person
Interested persons are invited to submit written comments to this notice within 30 days of this publication. Comments should be sent to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120.
Persons with a disability may use the AT&T Relay Service by calling (800) 654-5984 (TDD users) or (800) 654-5988 (Voice users). Persons who require another alternative format should contact Thomas Vracarich at (717) 783-2209.
FEATHER O. HOUSTOUN,
SecretaryFiscal Note: 14-NOT-143. No fiscal impact; (8) recommends adoption. Price changes to the Medical Assistance Fee Schedule are included in the Medical Assistance--Outpatient appropriations in the General Appropriations Act and the Governor's Budget.
[Pa.B. Doc. No. 97-693. Filed for public inspection May 2, 1997, 9:00 a.m.]
