Medical Assistance Program Fee Schedule Revisions [42 Pa.B. 5705]
[Saturday, September 1, 2012]The Department of Public Welfare (Department) is announcing changes to the Medical Assistance (MA) Program Fee Schedule for select renal dialysis procedure codes, including the addition of pricing modifiers and the establishment of MA Program fees.
Fee Schedule Revisions
On March 15, 2012, the Department added Provider Type 30, Provider Specialty 300 and Place of Service 65 with the pricing modifiers U7 and U8 to procedure codes 90945 and 90947 on the MA Program Fee Schedule and established new MA Program fees.
The U7 pricing modifier reflects an MA Program fee of $115 per dialysis treatment at a renal dialysis facility. The combination of the U8 pricing modifier and the 22 informational modifier reflects an MA Program fee of $165 per dialysis procedure for backup visits at a facility. MA Program regulations in 55 Pa. Code § 1128.53 (relating to limitations on payment) limits backup visits to no more than 15 in 1 calendar year and further states that backup visits are ''dialysis procedures provided at a facility when a patient is required to resume treatment at the facility following home dialysis treatment. Backup services may be necessitated by worsening of the patient's condition, absence of the dialysis treatment partner, or for the purpose of training a new partner or retraining for a new procedure to be managed in the home.''
Fiscal Impact
This change is anticipated to have minimal 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 Deputy Secretary's Office, Attention: 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 to the MA Program Fee Schedule.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
GARY D. ALEXANDER,
SecretaryFiscal Note: 14-NOT-788. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 12-1702. Filed for public inspection August 31, 2012, 9:00 a.m.]
