NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Medical Assistance Program Fee Schedule; Addition of Telehealth Technology Code and Informational Modifier for Consultations Performed Using Telecommunication Technology
[37 Pa.B. 6237]
[Saturday, November 24, 2007]The Department of Public Welfare (Department) announces, effective December 1, 2007, it is adding a telehealth informational modifier and a telehealth technology procedure code to the Medical Assistance (MA) Program Fee Schedule for consultations related to high-risk obstetrical care and psychopharmacology that are rendered using telecommunication technology, including video conferencing and telephone.
Description of Services
The Department recognizes that some MA recipients may have limited access to consultations with maternal fetal medicine specialists and psychiatrists. This limited access may inhibit some MA recipients from receiving timely diagnosis, treatment and monitoring. While face-to-face consultations with the patient are preferred whenever possible, there are instances where, due to a shortage of providers, rural access issues or the patient's particular condition or disability, this is not possible. Telehealth, which is the use of electronic communication equipment for the delivery of medical services, has been found to be an effective tool in increasing patient access to specialists and mental health providers, improving quality of care and promoting better communication and coordination among providers.
There are fewer than 100 maternal fetal medicine specialists enrolled in the MA Program. The Department anticipates that in cases of high-risk pregnancy, increased access to maternal fetal medicine specialists will further improve birth outcomes and reduce neonatal intensive care unit admissions for the newborn child, as well as reduce costs to the MA Program.
Additionally, the Department has reviewed prescribing patterns of providers in the fee-for-service delivery system and found that the majority of all psychotropic medications are not being prescribed by psychiatrists. The Department anticipates that increased access to psychiatric consultations will enhance appropriate utilization of psychotropic medications.
Fee Schedule
Effective December 1, 2007, the Department is adding a telehealth informational modifier and a technology procedure code to the MA Program Fee Schedule for consultations related to high-risk obstetrical care and psycho- pharmacology that are rendered using telecommunication technology, including video conferencing and telephone.
The GT informational modifier is being added to the MA Program Fee Schedule for maternal fetal medicine specialists and psychiatrists, to be used in conjunction with consultation procedure codes 99241, 99242, 99243, 99244 and 99245, to bill for consultations rendered using telecommunication technology.
Procedure code Q3014 and the GT informational modifier are being added to the MA Program Fee Schedule for use by physicians, certified registered nurse practitioners and certified nurse midwives when a consultation, rendered using telecommunication technology, takes place as part of an office visit billed using office visit procedure codes 99213, 99214 and 99215. The procedure code description and MA fee are as follows:
Procedure Code Informational
ModifierProcedure Description MA Fee Q3014 GT Telehealth originating site facility fee $15.72 Specific instructions for the use of these procedure codes and modifiers will be included in an MA bulletin that will be issued to affected providers before December 1, 2007.
Fiscal Impact
It is estimated that the addition of these services to the MA Program Fee Schedule will result in costs to the Medical Assistance Outpatient Program of $0.388 million ($0.196 million in State funds) in Fiscal Year (FY) 2007-2008 and $0.931 million ($0.468 million in State funds) in FY 2008-2009. It is expected that in year 2 these additional costs will be offset by savings through the improved health outcomes of the affected populations, resulting in lower costs to the MA Program.
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 revision to the MA Program Fee Schedule.
Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-533. (1) General Fund; (2) Implementing Year 2007-08 is $196,000; (3) 1st Succeeding Year 2008-09 is $468,000; 2nd Succeeding Year 2009-10 is $468,000; 3rd Succeeding Year 2010-11 is $468,000; 4th Succeeding Year 2011-12 is $468,000; 5th Succeeding Year 2012-13 is $468,000; (4) 2006-07 Program--$671,472,000; 2005-06 Program--$945,950,000; 2004-05 Program--$842,991,000; (7) Medical Assistance-Outpatient; (8) recommends adoption. Funds have been included in the budget to cover these increases.
[Pa.B. Doc. No. 07-2125. Filed for public inspection November 21, 2007, 9:00 a.m.]
No part of the information on this site may be reproduced for profit or sold for profit.This material has been drawn directly from the official Pennsylvania Bulletin full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
