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PA Bulletin, Doc. No. 13-1137

NOTICES

Medical Assistance Program Fee Schedule Revisions; 2013 Healthcare Common Procedure Coding System Updates; Prior Authorization Requirements

[43 Pa.B. 3436]
[Saturday, June 22, 2013]

 The Department of Public Welfare (Department) announces changes to the Medical Assistance (MA) Program Fee Schedule. These changes are effective for dates of service on and after June 24, 2013.

Fee Schedule Revisions

 The Department is adding and end-dating procedure codes as a result of implementing the 2013 updates made by the Centers for Medicare and Medicaid Services (CMS) to the Healthcare Common Procedure Coding System (HCPCS). The Department is also adding and end-dating other procedure codes. As follows, some of the procedure codes being added to the MA Program Fee Schedule will require prior authorization.

 Fees for the new procedure codes will be published in an MA Bulletin that will be issued to all providers.

 The following procedure codes are being added to the MA Program Fee Schedule as a result of the 2013 HCPCS updates:

Procedure Codes and Modifiers

22586 22586 (80) 23473 (RT) 23473 (LT) 23473 (50)
23473 (80)(RT) 23473 (80)(LT) 23473 (80)(50) 23474 (RT) 23474 (LT)
23474 (50) 23474 (80)(RT) 23474 (80)(LT) 23474 (80)(50) 24370 (RT)
24370 (LT) 24370 (50) 24370 (80)(RT) 24370 (80)(LT) 24370 (80)(50)
24370 (SG) 24371 (RT) 24371 (LT) 24371 (50) 24371 (80)(RT)
24371 (80)(LT) 24371 (80)(50) 24371 (SG) 32554 (RT) 32554 (LT)
32554 (50) 32554 (SG) 32555 (RT) 32555 (LT) 32555 (50)
32555 (SG) 32556 (RT) 32556 (LT) 32556 (50) 32556 (SG)
32557 (RT) 32557(LT) 32557(50) 32557(SG) 32701
32701 (SG) 36221 36221 (SG) 36222 (RT) 36222 (LT)
36222 (50) 36222 (SG) 36223 (RT) 36223 (LT) 36223 (50)
36223 (SG) 36224 (RT) 36224 (LT) 36224 (50) 36224 (SG)
36225 (RT) 36225 (LT) 36225 (50) 36225 (SG) 36226 (RT)
36226 (LT) 36226 (50) 36226 (SG) 36227 36228
37197 37197 (SG) 37211 37211 (SG) 37212
37212 (SG) 37213 37214 38243 38243 (SG)
52287 52287 (SG) 64615 64615 (SG) 78012
78012 (TC) 78012 (26) 78013 78013 (TC) 78013 (26)
78014 78014 (TC) 78014 (26) 78071 78071 (TC)
78071 (26) 78072 (26) 82777 86711 86828
86829 86830 86831 86832 86833
86834 86835 87631 87632 87633
87910 87912 90672 90686 90791
90792 90792(HB) 90832 90832 (HB) 90834
90834 (HB) 90837 90837 (HB) 92920 92920 (SG)
92921 92924 92924 (SG) 92925 92928
92928 (SG) 92929 92933 92933 (SG) 92934
92937 92937 (SG) 92938 92941 92941 (SG)
92943 92943 (SG) 92944 93653 93653 (SG)
93654 93654 (SG) 93655 93656 93656 (SG)
93657 95017 95018 95076 95079
95782 95782 (TC) 95782 (26) 95783 95783 (TC)
95783 (26) 95907 95907 (TC) 95907 (26) 95908
95908 (TC) 95908 (26) 95909 95909 (TC) 95909 (26)
95910 95910 (TC) 95910 (26) 95911 95911 (TC)
95911 (26) 95912 95912 (TC) 95912 (26) 95913
95913 (TC) 95913 (26) 95924 95924 (TC) 95924 (26)
A4435 D1208 G0458 G0458 (SG) J0890

 The following procedure codes are being added to the MA Program Fee Schedule as a result of significant program exception requests:

Procedure Codes and Modifiers

49041 49041 (SG) 92583 92986 92986 (SG)
J0886

 The following procedure codes are being end-dated from the MA Program Fee Schedule either as a result of the 2013 HCPCS updates or because they were previously end-dated by CMS:

Procedure Codes

31656 31715 32420 32421 32422 37201
37203 37209 43234 65805 71040 71060
75650 75660 75662 75665 75671 75676
75680 75685 75900 75961 78000 78001
78003 78006 78007 78010 78011 83890
83891 83892 83893 83894 83896 83897
83898 83900 83901 83903 83904 83905
83906 83907 83908 83909 83912 83913
88384 88385 88386 90718 90801 90802
90804 90805 90806 90807 90808 90809
90810 90811 90812 90813 90814 90815
90816 90817 90818 90819 90821 90822
90862 92980 92981 92982 92984 92995
92996 93651 93652 95010 95015 95075
95900 95903 95904 95934 95936 D1203
E1065 G0290 G0291 Q4055 S3818 S3819
S3820 S3822 S3823

 Additionally, the Department is end-dating the following procedure code because it is an operative technique and integral to the surgical procedure; therefore, it is not eligible for separate payment:

Procedure Code Procedure Description
69990 Microsurgical techniques, requiring use of operating microscope (list separately in addition to code for primary procedure)

 No new authorizations will be issued for this procedure code on and after June 24, 2013. Providers should submit claims using the end-dated procedure code, as set forth in the authorization issued by the Department. The Department will accept claims with the end-dated procedure code until June 24, 2014, for those services that were previously prior authorized.

Prior Authorization Requirements

 The following procedure codes being added to the MA Program Fee Schedule are considered advanced radiology services and will require prior authorization as authorized under section 443.6(b)(7) of the Public Welfare Code (62 P. S. § 443.6(b)(7)) and as described in MA Bulletin 99-08-08 (Prior Authorization of Advanced Radiologic Imaging Services) which may be viewed online at http://services.dpw.state.pa.us/olddpw/bulletinsearch. aspx?BulletinId=4377.

Procedure Code Procedure Description
78071 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT)
78072 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently acquired computed tomography (CT) for anatomical localization

Updates to Procedure Codes Currently on the MA Program Fee Schedule

 The Department will be adding pricing/informational modifiers (UB), (U7) and ((UB) (HB)) to the following procedure codes currently on the MA Program Fee Schedule:

Procedure Codes
99201 99211

Fiscal Impact

 There is no fiscal impact anticipated in Fiscal Year (FY) 2012-2013. The estimated cost for FY 2013-2014 is $0.599 million ($0.277 million in State funds). The estimated cost for FY 2014-2015 is $0.450 million ($0.210 million in State funds).

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 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).

BEVERLY D. MACKERETH , 
Acting Secretary

Fiscal Note: 14-NOT-824. (1) General Fund; (2) Implementing Year 2012-13 is $0; (3) 1st Succeeding Year 2013-14 is $277,000; 2nd Succeeding Year 2014-15 is $210,000; 3rd Succeeding Year 2015-16 is $210,000; 4th Succeeding Year 2016-17 is $210,000; 5th Succeeding Year 2017-18 is $210,000; (4) 2011-12 Program—$645,095,000; 2010-11 Program—$487,929,000; 2009-10 Program—$435,939,000; (7) MA—Outpatient; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 13-1137. Filed for public inspection June 21, 2013, 9:00 a.m.]



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