NOTICES

DEPARTMENT OF HUMAN SERVICES

Clinical Laboratory Improvement Amendments Excluded Laboratory Services Update; Medical Assistance Fee Schedule Revisions

[48 Pa.B. 1239]
[Saturday, February 24, 2018]

 The Department of Human Services (Department) announces changes to the Medical Assistance (MA) Program Fee Schedule. These changes are effective for dates of service on and after February 26, 2018.

 Each year, the Centers for Medicare & Medicaid Services provides an updated list of Current Procedural Terminology (CPT) codes that are laboratory tests under section 353 of the Clinical Laboratory Improvement Amendments of 1988 (CLIA) (42 U.S.C.A. § 263a), that are excluded from CLIA certificate requirements under the CLIA regulations, 42 CFR Part 493 (relating to laboratory requirements). The Department identified seven procedure codes in this list to add to the MA Fee Schedule, and six codes that need to be opened to additional provider types, provider specialties and places of service, to make these services available outside a laboratory setting.

 Therefore, the Department is adding certain outpatient laboratory CPT procedure codes to the MA Program Fee Schedule that are excluded from CLIA certificate requirements. In addition, the Department is adding certain Provider Types (PT), Provider Specialties (Spec) and Places of Service (POS) to certain outpatient laboratory CPT procedure codes that are excluded from CLIA certificate requirements and already open on the MA Program Fee Schedule.

 The Department will issue an MA Bulletin to inform providers of the updates.

Additions to the MA Fee Schedule

 The Department is adding the following procedure codes with the associated PT, Spec and POS combinations to the MA Program Fee Schedule:

Procedure Code	Description	Provider Type	Provider Specialty	Place of Service	MA Fee	Prior Auth.	Units	Limits
83013	Helicobacter pylori; breath test analysis for urease activity, nonradioactive isotope (for example, c-13)	01	016	23	$60.10	No	Per test	Once per day
		01	017	23
		01	183	22
		08	082	49
		09	All	11
		28	280	81
		31	All	11
86077	Blood bank physician services; difficult cross match and/or evaluation of irregular antibody(s), interpretation and written report	01	017	23	$41.83	No	Per procedure	Once per day
		01	183	22
		08	082	49
		28	280	81
		31	All	11, 21, 23
86078	Blood bank physician services; investigation of transfusion reaction including suspicion of transmissible disease, interpretation and written report	01	017	23	$41.56	No	Per procedure	Once per day
		01	183	22
		08	082	49
		28	280	81
		31	All	11, 21, 23
86079	Blood bank physician services; authorization for deviation from standard blood banking procedures (for example, use of outdated blood, transfusion of Rh incompatible units), with written report	01	017	23	$41.56	No	Per procedure	Once per day
		01	183	22
		08	082	49
		28	280	81
		31	All	11, 21, 23
88329	Pathology consultation during surgery	01	016	23	$29.77	No	Per procedure	Once per day
		01	017	23
		01	183	22
		08	082	49
		27	All	11, 21, 24
		28	280	81
		31	All	11, 21, 24
88738	Hemoglobin (Hgb), quantitative, transcutaneous	01	016	23	$4.47	No	Per test	Once per day
		01	017	23
		01	183	22
		08	082	49
		09	All	11
		28	280	81
		31	All	11
		33	335	11
89049	Caffeine halothane contracture test for malignant hyperthermia susceptibility, including interpretation and report	01	183	22	$53.03	No	Per test	Once per day
		28	280	81

Updates to Procedure Codes Currently on the MA Program Fee Schedule

 The Department is adding the following PT, Spec and POS combinations to the procedure codes:

Procedure Code	Description	Provider Type	Provider Specialty	Place of Service
86485	Skin test; candida	08	082	49
		09	All	11
		31	All	11
		33	335	11
86490	Skin test; coccidioidomycosis	08	082	49
		09	All	11
		31	All	11
		33	335	11
86510	Skin test: histoplasmosis	08	082	49
		09	All	11
		31	All	11
		33	335	11
87900	Infectious agent drug susceptibility phenotype prediction using regularly updated genotype bioinformatics	31	All	11
88720	Bilirubin, total transcutaneous	08	082	49
		09	All	11, 12
		31	All	11, 12
		33	335	11, 12
88740	Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin	08	082	49
		09	All	11
		31	All	11

Fiscal Impact

 The estimated cost for Fiscal Year 2017-2018 is $0.038 million ($0.018 million in State funds).

Public Comment

 Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, 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).

TERESA D. MILLER, 
Acting Secretary

 Fiscal Note: 14-NOT-1210. (1) General Fund; (2) Implementing Year 2017-18 is $18,000; (3) 1st Succeeding Year 2018-19 through 5th Succeeding Year 2022-23 are $74,000; (4) 2016-17 Program—$450,970,000; 2015-16 Program—$392,918,000; 2014-15 Program—$564,772,000; (7) MA—Fee-for-Service; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 18-303. Filed for public inspection February 23, 2018, 9:00 a.m.]

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