NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Addition of a New Neonatal Intensive Care Procedure Code Fee Increase for Selected Neonatal Intensive Care Services
[30 Pa.B. 4687] By this notice, under to 55 Pa. Code § 1150.61(a), the Department of Public Welfare (Department) announces that effective September 1, 2000, the following new neonatal intensive care procedure code has been added to the Medical Assistance (MA) Program Fee Schedule.
Procedure Code Description of Service MA Fee 99298 Subsequent neonatal intensive care, per day, for the evaluation and management of the recovering very low birth weight infant (less than 1,500 grams) $80 Under to 55 Pa. Code § 1150.61(a), the Department also announces that the fees for the following neonatal intensive care services are increased retroactively, effective August 1, 1996, as follows:
Procedure Increased Fee Code Description of Service Current Fee Effective 8-1-1996 99295 Initial neonatal intensive care, per day, for the evaluation and management of a critically ill neonate or infant. (This code is reserved for day of admission.) $130.50 $450 99296 Subsequent neonatal intensive care, per day, for the evaluation and management of critically ill and unstable neonate or infant. $73.50 $230 99297 Subsequent neonatal intensive care, per day, for the evaluation and management of a critically ill though stable neonate or infant. $52.50 $130
Procedure codes 99295, 99296, 99297 and 99298 are bundled (global) codes, which represent care starting with the date of admission to the neonatal intensive care unit and may be billed only once per day, per patient. Care rendered includes management; monitoring and treatment of the patient including enteral and parenteral nutritional maintenance, metabolic and hematologic maintenance; pharmacologic control of the circulatory system; parent counseling; case management services and personal direct supervision of the health care team in performance of cognitive and procedural activities.
In addition to those services listed above, the following procedures are also included in the bundled (global) neonatal codes (99295, 99296, 99297 and 99298): umbilical venous (36510) and umbilical arterial (36620) catheters, central (36488, 36490) or peripheral vessel catheterization (36000), other arterial catheters (36140, 36620), oral or nasogastric tube placement, endotracheal intubation (31500), lumbar puncture (62270), suprapubic bladder aspiration (51000), initiation and management of mechanical ventilation (94656, 94657) or continuous positive airway pressure (CPAP) 94660, surfactant administration, intravascular fluid administration, transfusion of blood components (36430, 36440), vascular punctures (36420, 36600), invasive or noninvasive electronic monitoring of vital signs, bedside pulmonary function testing, and/or monitoring or interpretation of blood gases or oxygen saturation (94760-94762). A provider must bill for neonatal intensive care services using the bundled (global) procedure codes (99295, 99296, 99297 and 99298) and may not bill separately for services performed, which are listed above.
When the neonate is no longer considered to be critically ill and attains a body weight which exceeds 1,500 grams, the codes for Subsequent Hospital Care (99231- 99233) should be used.
Fiscal Impact
The estimated cost for Fiscal Year 2000-2001 including all retroactive costs as a result of the addition of the new neonatal intensive care procedure code and the retroactive rate increase for selected neonatal intensive care procedure codes is $3.619 million ($1.679 million in State funds). The estimated cost for Fiscal Year 2001-2002 is $1.306 million ($0.600 million in State funds).
Contact Person
A copy of this notice is available for review at Local County Assistance Offices. Interested persons are invited to submit written comments to this notice within 30 days of this publication. These comments should be sent to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office, Attention: Suzanne Love, 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 should contact Thomas Vracarich in the Office of Legal Counsel at (717) 783-2209.
FEATHER O. HOUSTOUN,
SecretaryFiscal Note: 14-NOT-256. (1) General Fund; (2) Implementing Year 2000-01 is $1.659 million; (3) 1st Succeeding Year 2001-02 is $0.600 million; 2nd Succeeding Year 2002-03 is $0.600 million; 3rd Succeeding Year 2003-04 is $0.600 million; 4th Succeeding Year 2004-05 is $0.600 million; 5th Succeeding Year 2005-06 is $0.600 million; (4) 1999-00 Program--$622,669 million; 1998-99 Program--$695,935 million; 1997-98 Program--$662.740 million; (7) Medical Assistance--Outpatient; (8) recommends adoption.
Funds are available in the Department's budget to cover the costs projected due to this fee increase.
[Pa.B. Doc. No. 00-1524. Filed for public inspection September 1, 2000, 9:00 a.m.]
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