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PA Bulletin, Doc. No. 14-53


Medical Assistance Program Fee Schedule; Addition of Procedure Code for Vaccine Administration

[44 Pa.B. 136]
[Saturday, January 4, 2014]

 In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Public Welfare (Department) announces the addition of the following procedure codes to the Medical Assistance (MA) Program Fee Schedule for the administration of a quadrivalent influenza vaccine effective for dates of service on and after January 6, 2014.

Description MA
90685 Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use $10
90688 Influenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use $10

 The United States Food and Drug Administration (FDA) approved use of Fluzone® Quadrivalent vaccine on June 7, 2013. The Department is adding procedure code 90685 to the MA Program Fee Schedule to enable it to identify when a practitioner administers preservative free quadrivalent influenza vaccine, such as Fluzone® Quadrivalent, to a child 6-35 months of age.

 The FDA approved use of FluLaval® Quadrivalent vaccine on August 16, 2013. The Department is adding procedure code 90688 to the MA Program Fee Schedule to enable it to identify when a practitioner administers quadrivalent influenza vaccine containing preservative, such as FluLaval® Quadrivalent, to individuals 3 years of age and older.

 The Department will issue an MA Bulletin to providers enrolled in the MA Program specifying the procedures for billing of the administration of the vaccines.

 The MA fee for the administration of each vaccine is $10 per administration. Physicians who qualify for the increased primary care services fees under the Patient Protection and Affordable Care Act, as outlined in MA Bulletin 31-13-34, ''Implementation of the Medical Assistance Program's Physician Fee Increases for Select Primary Care Services,'' will be paid the enhanced rate of $23.14 per administration.

Fiscal Impact

 The Department anticipates no fiscal impact as a result of adding procedure codes 90685 and 90688 to the MA Program Fee Schedule, as there is an existing procedure code on the fee schedule that is being used for the administration of these vaccines. The addition of these procedure codes will not increase utilization.

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 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 at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


Fiscal Note: 14-NOT-851. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 14-53. Filed for public inspection January 3, 2014, 9:00 a.m.]

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