1186 Medical Assistance program fee schedule revisions; addition of HCPCS codes to Medical Assistance program fee schedule

DEPARTMENT OF
PUBLIC WELFARE

Medical Assistance Program Fee Schedule Revisions; Addition of HCPCS Codes to Medical Assistance Program Fee Schedule

[35 Pa.B. 3470]

   This notice announces revisions to the Medical Assistance (MA) Program Fee Schedule. The MA Program Fee Schedule does not list several Healthcare Common Procedure Coding System (HCPCS) codes created by the Centers for Medicare and Medicaid Services (CMS) when it updated the HCPCS codes in 2004. The Department of Public Welfare (Department) is adding these codes to the MA Program Fee Schedule to enable providers to use these codes in place of the HCPCS codes that the Department end-dated effective February 7, 2005, as a result of the 2004 CMS HCPCS update. See 35 Pa.B. 803 (February 5, 2005).

   The following HCPCS procedure codes are being added to the MA Program's Fee Schedule effective for dates of service on or after February 7, 2005:

Code	Modifiers	Terminology
E0950	NU, RR	Wheelchair accessory, tray, each
E0952	NU, RR	Toe loop/holder, any type, each
E0959	NU, RR	Manual wheelchair accessory, adapter for amputee, each
E0961	NU, RR	Manual wheelchair accessory, wheel lock brake extension (handle), each
E0966	NU, RR	Manual wheelchair accessory, headrest extension, each
E0967	NU, RR	Manual wheelchair accessory, hand rim with projections, any type, replacement only, each
E0972	NU, RR	Wheelchair accessory, transfer board or device, each
E0974	NU, RR	Manual wheelchair accessory, anti-rollback device, each
E0992	NU, RR	Manual wheelchair accessory, solid seat insert
E0995	NU, RR	Wheelchair accessory, calf rest/pad, each
E1226	NU, RR	Wheelchair accessory, manual fully reclining back, (recline greater than 80°), each
E1810	RT, LT, 50	Dynamic adjustable knee extension/flexion device, includes soft interface material

   Fees for the added procedure codes will be published in a Medical Assistance Bulletin (MAB) that will be issued to providers. Items of durable medical equipment priced at $100 or higher, which are subject to prior authorization under section 443.6(b)(2) of the Public Welfare Code (62 P. S. § 443.6(b)(2)) regarding reimbursement for certain MA items and services, will be identified in the MAB.

Fiscal Impact

   The fiscal note was prepared under section 612 of The Administrative Code of 1929 (71 P. S. § 232).

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 revision to the fee schedule.

   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-429. No fiscal impact; (8) recommends adoption. The fees for the new codes remain the same as those for the obsolete codes that they are replacing.

[Pa.B. Doc. No. 05-1186. Filed for public inspection June 17, 2005, 9:00 a.m.]