Pennsylvania Bulletin

PA Bulletin, Doc. No. 03-2036

NOTICES

Medical Assistance Program Fee Schedule Revision

[33 Pa.B. 5257]

   The Department of Public Welfare (Department) will revise payment rates for select procedure codes effective November 1, 2003.

   The Pennsylvania Medicaid State Plan (State Plan) specifies that maximum fees for services covered under the Medical Assistance (MA) Program are to be determined on the basis of the following: fees will not exceed the Medicare upper limit when applicable; fees will be consistent with efficiency, economy and quality of care; and fees will be sufficient to assure the availability of services to clients.

   Through the enactment of section 4551(a) of the Balanced Budget Act of 1997 (42 U.S.C.A. § 1395m(a)(14)), Congress reduced payment levels for certain Medicare items. The Department is adjusting the MA Program Fee Schedule payment rates for procedure codes to equal the Medicare approved amount. Revision of these fees is necessary to comply with the State Plan and to avoid Federal disallowances.

   In addition, the Department is making specific technical payment adjustments to an additional 16 procedure codes.

Procedure

   Payment rates for the following procedure codes will be effective November 1, 2003. See the ''DME Codes with Fees Exceeding 100% Medicare'' and ''Technical Revision Codes'' that follow.

Fiscal Note

   It is anticipated that this revision will result in a savings of $0.314 million in total funds ($0.181 million in Federal funds, $0.133 million in State funds) for the period July 1, 2003, through June 30, 2004. The estimated savings for the period July 1, 2004, through June 30, 2005, are $0.627 million ($0.339 million in Federal funds, $0.288 million in State funds).

Public Comment

   Interested persons are invited to submit written comments to this notice within 30 days of publication 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 considered in subsequent revisions to the fee schedule.

   Persons with a disability may use the AT&T Relay Service, (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

ESTELLE B. RICHMAN,
Secretary

   Fiscal Note: 14-NOT-373. No fiscal impact; (8) recommends adoption.

DME Codes with Fees Exceeding 100% Medicare

Code Description Fee Revision

L5845 Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable $1,411.11

L5644 Addition to lower extremity, above knee, wood socket $473.68

L5650 Additions to lower extremity, total contact, above knee or knee disarticulation socket $391.51

L6586 Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, USMC or equal pylon, no cover, direct formed $1,564.03

L5634 Addition to lower extremity, Symes type, posterior opening (Canadian) socket $243.95

L0540 LSO, lumbar flexion (Williams flexion type) $370.14

L5970 All lower extremity prostheses, foot, external keel, SACH foot $176.06

L2340 Addition to lower extremity, pretibial shell, molded to patient model $433.33

E0142 Rigid walker, wheeled, with seat $171.98

L6630 Upper extremity addition, stainless steel, any wrist $172.84

E0177 Water pressure pad or cushion, nonpositioning $106.14

E0176 Air pressure pad or cushion, nonpositioning $107.11

E0178 Gel or gel-like pressure pad or cushion, nonpositioning $121.34

L6865 Terminal device, hand, passive hand $283.83

E0560^* Humidifier, durable for supplemental humidification during IPPB treatment or oxygen delivery $20.10

L5680 Addition to lower extremity, below knee, thigh lacer, nonmolded $277.76

L0130 Cervical, flexible, thermoplastic collar, molded to patient $148.79

E0164 Commode chair, mobile, with fixed arms $169.43

L3974 SEWHO, addition to mobile arm support, supinator $142.55

L3908 WHFO, wrist extension control cock-up, nonmolded $49.56

L5618 Addition to lower extremity, test socket, Symes $253.76

L5910 Addition, endoskeletal system, below knee, alignable system $292.51

E0946^* Fracture, frame, dual with cross bars, attached to bed, (for example, Balken, four-poster) $59.16

L3650 Shoulder orthosis, figure of eight design abduction restrainer $50.06

E0941^* Gravity assisted traction device, any type $43.41

L1085 Addition to CTLSO or scoliosis orthosis, outrigger, bilateral with vertical extensions $134.63

L6637 Upper extremity addition, nudge control elbow lock $332.31

E0202^* Phototherapy (bilirubin) light with photometer $62.61

L1610 Hip orthosis, abduction control of hip joints, flexible, (Frejka cover only) $42.81

E0186^* Air pressure mattress $20.30

E0920^* Fracture frame, attached to bed, includes weights $46.14

L3972 SEWHO, addition to mobile arm support, offset or lateral rocker arm with elastic balance control $168.07

E0145^* Walker, wheeled, with seat and crutch attachments $17.64

E0187^* Water pressure mattress $23.21

L2425 Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint $112.64

E0431^* Portable gaseous oxygen system, rental; includes regulator, flowmeter, humidifier, cannula or mask, and tubing $35.97

E0434^* Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing $35.97

L2360 Addition to lower extremity, extended steel shank $38.95

E0942 Cervical head harness/halter $19.85

E0180^* Pressure pad, alternating with pump $20.79

E0291^* Hospital bed, fixed height, without side rails, without mattress $54.30

E0181^* Pressure pad, alternating with pump, heavy duty $23.06

L6641 Upper extremity addition, excursion amplifier, pulley type $150.73

L3660 Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing $75.71

L3930 WHFO, finger extension, with wrist support $54.09

L0150 Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece) $90.27

L5629 Addition to lower extremity, below knee, acrylic socket $330.29

E0781^* Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient $225.14

E0565^* Compressor, air power source for equipment which is not self-contained or cylinder driven $61.01

E0910^* Trapeze bars, AKA patient helper, attached to bed, with grab bar $20.00

E0930^* Fracture frame, free standing, includes weights $45.69

B4083 Stomach tube--levine type $2.27

L1815 Knee orthosis, elastic with condylar pad(s) $78.51

E0480^* Percussor, electric or pneumatic, home model $43.94

L5620 Addition to lower extremity, test socket, below knee $222.96

E0261^* Hospital bed, semielectric (head and foot adjustment), with any type side rails, without mattress $128.65

E0146^* Folding walker, wheeled, with seat $16.18

E0665^* Nonsegmental pneumatic appliance for use with pneumatic compressor, full arm $14.07

E0550^* Humidifier, durable for extensive supplemental humidification during IPPB treatments or oxygen delivery $50.13

E0666^* Nonsegmental pneumatic appliance for use with pneumatic compressor, half leg $14.23

L3936 Wrist hand finger orthosis, palmer $65.61

L2375 Addition to lower extremity, torsion control, ankle joint and half solid stirrup $106.61

E0290^* Hospital bed, fixed height, without side rails, with mattress $74.74

L1830 Knee orthosis, immobilizer, canvas longitudinal $69.84

E1372 Immersion external heater for nebulizer $163.03

E0182^* Pump for alternating pressure pad $26.18

E0110 Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips $65.95

E0293^* Hospital bed, variable height, hi-lo, without side rails, without mattress $71.51

E0660^* Nonsegmental pneumatic appliance for use with pneumatic compressor, full leg $16.63

L8480 Prosthetic sock, single ply, fitting, above knee, each $7.38

L2415 Addition to knee joint, cam lock (Swiss, French, bail types), each joint $95.43

E0271^* Mattress, innerspring $23.06

E0250^* Hospital bed, fixed height, with any type side rails, with mattress $97.76

E0165^* Commode chair, stationary, with detachable arms $15.79

E0251^* Hospital bed, fixed height, with any type side rails, without mattress $74.08

L6616 Upper extremity addition, additional disconnect insert for locking wrist unit, each $69.35

E0255^* Hospital bed, variable height, hi-lo, with any type side rails, with mattress $114.37

E0297^* Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress $140.67

E0600^* Suction pump, home model, portable $45.79

E0143^* Folding walker, wheeled, without seat $21.59

E0292^* Hospital bed, variable height, hi-lo, without side rails, with mattress $81.07

A4347 Male external catheter with or without adhesive, with or without antireflux device; per dozen $20.27

E0860^* Traction equipment, overdoor, cervical $6.51

L2810 Addition to lower extremity orthosis, knee control, condylar pad $78.39

L3800 Wrist hand finger orthoses, short opponens, no attachments $147.29

A4355 Irrigation tubing set for continuous bladder irrigation through a three-way indwelling Foley catheter $8.91

L2310 Addition to lower extremity, abduction bar-straight $107.60

A4311 Insertion tray without drainage bag with indwelling catheter, Foley type, two-way latex with coating (Teflon, silicone, silicone elastomer or hydrophilic, and the like) $12.61

E0935^* Passive motion exercise device $22.73

A5063 Ostomy pouch, drainable; for use on barrier with flange (two-piece system) $2.20

E0968^* Commode seat, wheelchair $17.93

E0256^* Hospital bed, variable height, hi-lo, with any type side rails, without mattress $78.09

E0944 Pelvic belt/harness/boot $45.88

A4556 Electrodes, for example, apnea monitor (black carbon electrodes) $10.32

L1070 Addition to CTLSO or scoliosis orthosis, trapezius sling $88.48

E0655^* Nonsegmental pneumatic appliance for use with pneumatic compressor, half arm $12.68

E0776^* IV pole $18.65

L5688 Addition to lower extremity, below knee, waist belt, webbing $48.99

A5053 Pouch, closed; for use on faceplate $1.74

A5054 Pouch, closed; for use on barrier with flange (two-piece) $1.79

A5121 Skin barrier; solid, 6 × 6 or equivalent, each $6.54

A5052 Pouch, closed; without barrier (one-piece) $1.67

A4359 Urinary suspensory without leg bag $30.63

A4557 Lead wires, for example, apnea monitor $17.94

A5062 Pouch, drainable; without barrier attached (one-piece) $2.22

A6216 Gauze, nonimpregnated, nonsterile, pad size 16 sq. in. or less, without adhesive border, each dressing $0.05

Technical Revision Codes

Code Description Technical Fee Revision

A7000 Canister, disposable, used with suction pump, each $7.32

A7001 Canister, nondisposable, used with suction pump, each $26.21

A7002 Tubing, used with suction pump, each $3.04

A7003 Administration set, with small volume nonfiltered pneumatic nebulizer, disposable $2.40

A7004 Small volume nonfiltered pneumatic nebulizer, disposable $1.34

A7005 Administration set, with small volume nonfiltered pneumatic nebulizer, nondisposable $24.43

A7006 Administration set, with small volume filtered pneumatic nebulizer $7.15

A7007 Large volume nebulizer, disposable, unfilled, used with aerosol compressor $3.49

A7008 Large volume nebulizer, disposable, prefilled, used with aerosol compressor $9.66

A7009 Reservoir bottle, nondisposable, used with large volume ultrasonic nebulizer $33.32

A7010 Corrugated tubing, disposable, used with large volume nebulizer, 100 feet $20.49

A7012 Water collection device, used with large volume nebulizer $3.14

A7013 Filter, disposable, used with aerosol compressor $0.65

A7014 Filter, nondisposable, used with aerosol compressor or ultrasonic generator $3.55

A7015 Aerosol mask, used with DME nebulizer $1.45

A7016 Dome and mouthpiece, used with small volume ultrasonic nebulizer $5.73

^* Indicates rental

[Pa.B. Doc. No. 03-2036. Filed for public inspection October 17, 2003, 9:00 a.m.]

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Code	Description	Fee Revision
L5845	Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable	$1,411.11
L5644	Addition to lower extremity, above knee, wood socket	$473.68
L5650	Additions to lower extremity, total contact, above knee or knee disarticulation socket	$391.51
L6586	Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, USMC or equal pylon, no cover, direct formed	$1,564.03
L5634	Addition to lower extremity, Symes type, posterior opening (Canadian) socket	$243.95
L0540	LSO, lumbar flexion (Williams flexion type)	$370.14
L5970	All lower extremity prostheses, foot, external keel, SACH foot	$176.06
L2340	Addition to lower extremity, pretibial shell, molded to patient model	$433.33
E0142	Rigid walker, wheeled, with seat	$171.98
L6630	Upper extremity addition, stainless steel, any wrist	$172.84
E0177	Water pressure pad or cushion, nonpositioning	$106.14
E0176	Air pressure pad or cushion, nonpositioning	$107.11
E0178	Gel or gel-like pressure pad or cushion, nonpositioning	$121.34
L6865	Terminal device, hand, passive hand	$283.83
E0560^*	Humidifier, durable for supplemental humidification during IPPB treatment or oxygen delivery	$20.10
L5680	Addition to lower extremity, below knee, thigh lacer, nonmolded	$277.76
L0130	Cervical, flexible, thermoplastic collar, molded to patient	$148.79
E0164	Commode chair, mobile, with fixed arms	$169.43
L3974	SEWHO, addition to mobile arm support, supinator	$142.55
L3908	WHFO, wrist extension control cock-up, nonmolded	$49.56
L5618	Addition to lower extremity, test socket, Symes	$253.76
L5910	Addition, endoskeletal system, below knee, alignable system	$292.51
E0946^*	Fracture, frame, dual with cross bars, attached to bed, (for example, Balken, four-poster)	$59.16
L3650	Shoulder orthosis, figure of eight design abduction restrainer	$50.06
E0941^*	Gravity assisted traction device, any type	$43.41
L1085	Addition to CTLSO or scoliosis orthosis, outrigger, bilateral with vertical extensions	$134.63
L6637	Upper extremity addition, nudge control elbow lock	$332.31
E0202^*	Phototherapy (bilirubin) light with photometer	$62.61
L1610	Hip orthosis, abduction control of hip joints, flexible, (Frejka cover only)	$42.81
E0186^*	Air pressure mattress	$20.30
E0920^*	Fracture frame, attached to bed, includes weights	$46.14
L3972	SEWHO, addition to mobile arm support, offset or lateral rocker arm with elastic balance control	$168.07
E0145^*	Walker, wheeled, with seat and crutch attachments	$17.64
E0187^*	Water pressure mattress	$23.21
L2425	Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint	$112.64
E0431^*	Portable gaseous oxygen system, rental; includes regulator, flowmeter, humidifier, cannula or mask, and tubing	$35.97
E0434^*	Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing	$35.97
L2360	Addition to lower extremity, extended steel shank	$38.95
E0942	Cervical head harness/halter	$19.85
E0180^*	Pressure pad, alternating with pump	$20.79
E0291^*	Hospital bed, fixed height, without side rails, without mattress	$54.30
E0181^*	Pressure pad, alternating with pump, heavy duty	$23.06
L6641	Upper extremity addition, excursion amplifier, pulley type	$150.73
L3660	Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing	$75.71
L3930	WHFO, finger extension, with wrist support	$54.09
L0150	Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece)	$90.27
L5629	Addition to lower extremity, below knee, acrylic socket	$330.29
E0781^*	Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient	$225.14
E0565^*	Compressor, air power source for equipment which is not self-contained or cylinder driven	$61.01
E0910^*	Trapeze bars, AKA patient helper, attached to bed, with grab bar	$20.00
E0930^*	Fracture frame, free standing, includes weights	$45.69
B4083	Stomach tube--levine type	$2.27
L1815	Knee orthosis, elastic with condylar pad(s)	$78.51
E0480^*	Percussor, electric or pneumatic, home model	$43.94
L5620	Addition to lower extremity, test socket, below knee	$222.96
E0261^*	Hospital bed, semielectric (head and foot adjustment), with any type side rails, without mattress	$128.65
E0146^*	Folding walker, wheeled, with seat	$16.18
E0665^*	Nonsegmental pneumatic appliance for use with pneumatic compressor, full arm	$14.07
E0550^*	Humidifier, durable for extensive supplemental humidification during IPPB treatments or oxygen delivery	$50.13
E0666^*	Nonsegmental pneumatic appliance for use with pneumatic compressor, half leg	$14.23
L3936	Wrist hand finger orthosis, palmer	$65.61
L2375	Addition to lower extremity, torsion control, ankle joint and half solid stirrup	$106.61
E0290^*	Hospital bed, fixed height, without side rails, with mattress	$74.74
L1830	Knee orthosis, immobilizer, canvas longitudinal	$69.84
E1372	Immersion external heater for nebulizer	$163.03
E0182^*	Pump for alternating pressure pad	$26.18
E0110	Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips	$65.95
E0293^*	Hospital bed, variable height, hi-lo, without side rails, without mattress	$71.51
E0660^*	Nonsegmental pneumatic appliance for use with pneumatic compressor, full leg	$16.63
L8480	Prosthetic sock, single ply, fitting, above knee, each	$7.38
L2415	Addition to knee joint, cam lock (Swiss, French, bail types), each joint	$95.43
E0271^*	Mattress, innerspring	$23.06
E0250^*	Hospital bed, fixed height, with any type side rails, with mattress	$97.76
E0165^*	Commode chair, stationary, with detachable arms	$15.79
E0251^*	Hospital bed, fixed height, with any type side rails, without mattress	$74.08
L6616	Upper extremity addition, additional disconnect insert for locking wrist unit, each	$69.35
E0255^*	Hospital bed, variable height, hi-lo, with any type side rails, with mattress	$114.37
E0297^*	Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress	$140.67
E0600^*	Suction pump, home model, portable	$45.79
E0143^*	Folding walker, wheeled, without seat	$21.59
E0292^*	Hospital bed, variable height, hi-lo, without side rails, with mattress	$81.07
A4347	Male external catheter with or without adhesive, with or without antireflux device; per dozen	$20.27
E0860^*	Traction equipment, overdoor, cervical	$6.51
L2810	Addition to lower extremity orthosis, knee control, condylar pad	$78.39
L3800	Wrist hand finger orthoses, short opponens, no attachments	$147.29
A4355	Irrigation tubing set for continuous bladder irrigation through a three-way indwelling Foley catheter	$8.91
L2310	Addition to lower extremity, abduction bar-straight	$107.60
A4311	Insertion tray without drainage bag with indwelling catheter, Foley type, two-way latex with coating (Teflon, silicone, silicone elastomer or hydrophilic, and the like)	$12.61
E0935^*	Passive motion exercise device	$22.73
A5063	Ostomy pouch, drainable; for use on barrier with flange (two-piece system)	$2.20
E0968^*	Commode seat, wheelchair	$17.93
E0256^*	Hospital bed, variable height, hi-lo, with any type side rails, without mattress	$78.09
E0944	Pelvic belt/harness/boot	$45.88
A4556	Electrodes, for example, apnea monitor (black carbon electrodes)	$10.32
L1070	Addition to CTLSO or scoliosis orthosis, trapezius sling	$88.48
E0655^*	Nonsegmental pneumatic appliance for use with pneumatic compressor, half arm	$12.68
E0776^*	IV pole	$18.65
L5688	Addition to lower extremity, below knee, waist belt, webbing	$48.99
A5053	Pouch, closed; for use on faceplate	$1.74
A5054	Pouch, closed; for use on barrier with flange (two-piece)	$1.79
A5121	Skin barrier; solid, 6 × 6 or equivalent, each	$6.54
A5052	Pouch, closed; without barrier (one-piece)	$1.67
A4359	Urinary suspensory without leg bag	$30.63
A4557	Lead wires, for example, apnea monitor	$17.94
A5062	Pouch, drainable; without barrier attached (one-piece)	$2.22
A6216	Gauze, nonimpregnated, nonsterile, pad size 16 sq. in. or less, without adhesive border, each dressing	$0.05

Code	Description	Technical Fee Revision
A7000	Canister, disposable, used with suction pump, each	$7.32
A7001	Canister, nondisposable, used with suction pump, each	$26.21
A7002	Tubing, used with suction pump, each	$3.04
A7003	Administration set, with small volume nonfiltered pneumatic nebulizer, disposable	$2.40
A7004	Small volume nonfiltered pneumatic nebulizer, disposable	$1.34
A7005	Administration set, with small volume nonfiltered pneumatic nebulizer, nondisposable	$24.43
A7006	Administration set, with small volume filtered pneumatic nebulizer	$7.15
A7007	Large volume nebulizer, disposable, unfilled, used with aerosol compressor	$3.49
A7008	Large volume nebulizer, disposable, prefilled, used with aerosol compressor	$9.66
A7009	Reservoir bottle, nondisposable, used with large volume ultrasonic nebulizer	$33.32
A7010	Corrugated tubing, disposable, used with large volume nebulizer, 100 feet	$20.49
A7012	Water collection device, used with large volume nebulizer	$3.14
A7013	Filter, disposable, used with aerosol compressor	$0.65
A7014	Filter, nondisposable, used with aerosol compressor or ultrasonic generator	$3.55
A7015	Aerosol mask, used with DME nebulizer	$1.45
A7016	Dome and mouthpiece, used with small volume ultrasonic nebulizer	$5.73