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PA Bulletin, Doc. No. 20-695

NOTICES

DEPARTMENT OF HUMAN SERVICES

Medical Assistance Program Fee Schedule Revisions; 2020 Healthcare Common Procedure Coding System Updates; Prior Authorization Requirements

[50 Pa.B. 2722]
[Saturday, May 23, 2020]

 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 May 26, 2020.

 The Department is adding and end-dating procedure codes as a result of implementing the 2020 Healthcare Common Procedure Coding System (HCPCS) updates published by the Centers for Medicare & Medicaid Services. As follows, some of the procedure codes being added to the MA Program Fee Schedule will require prior authorization.

Procedure Codes Being Added or End-dated

 The Department is adding the following procedure codes, and procedure code and modifier combinations to the MA Program Fee Schedule as a result of the 2020 HCPCS updates:

Procedure Codes and Modifiers
15769 15769 (SG) 15771 15771 (SG) 15772
15773 15773 (SG) 15774 20700 20701
20702 20703 20704 20705 21601
21601 (SG) 21601 (80) 21602 21602 (80) 21603
21603 (80) 33016 33017 33018 33019
33858 33858 (80) 33859 33859 (80) 33871
33871 (80) 34717 34717 (80) 34718 34718 (80)
35702 (RT) 35702 (LT) 35702 (50) 35702 (RT) (80) 35702 (LT) (80)
35702 (50) (80) 35703 (RT) 35703 (LT) 35703 (50) 35703 (RT) (80)
35703 (LT) (80) 35703 (50) (80) 46948 46948 (SG) 49013
49014 62328 62328 (SG) 62329 62329 (SG)
66987 (SG) 66987 (RT) 66987 (LT) 66987 (50) 66988 (SG)
66988 (RT) 66988 (LT) 66988 (50) 74221 74221 (TC)
74221 (26) 74248 74248 (TC) 74248 (26) 78429
78429 (TC) 78429 (26) 78430 78430 (TC) 78430 (26)
78431 78431 (TC) 78431 (26) 78432 78432 (TC)
78432 (26) 78433 78433 (TC) 78433 (26) 78434
78434 (TC) 78434 (26) 78459 78459 (TC) 78459 (26)
78491 78491 (TC) 78491 (26) 78492 78492 (TC)
78492 (26) 78830 78830 (TC) 78830 (26) 78831
78831 (TC) 78831 (26) 78832 78832 (TC) 78832 (26)
78835 78835 (TC) 78835 (26) 80187 80285
81307 81308 92201 92202 93985
93985 (TC) 93985 (26) 93986 93986 (TC) 93986 (26)
95700 95705 95706 95707 95708
95709 95710 95711 95712 95713
95714 95715 95716 95717 95718
95719 95720 95721 95722 95723
95724 95725 95726 96156 (TJ) 96156 (U5) (TJ)
96156 (U3) (TM) 96156 (U4) (TM) 96158 (U3) (TJ) 96159 (U3) (TJ) 96164 (TJ)
96165 (TJ) 96167 (TJ) 96168 (TJ) 97129 97130
99490 D1551 D1551 (SG) D1552 D1552 (SG)
D1553 D1553 (SG) D1556 D1556 (SG) D1557
D1557 (SG) D1558 D1558 (SG) D8703 D8704
G2064 G2065 G2066

 The Department is end-dating the following procedure codes from the MA Program Fee Schedule as a result of the 2020 HCPCS updates:

Procedure Codes
19260 19271 19272 19304 20926 
33010 33011 33015 33860 33870
35721 35741 35761 43401 64402
64410 64413 74241 74245 74247
74249 74260 76930 78205 78206
78320 78607 78647 78710 78805
78806 78807 93299 95827 95831
95832 95833 95834 95950 95951
95953 95956 96150 96151 96152
96153 96154 97127 D1550 D1555
G0365

Prior Authorization Requirements

 The following procedure codes, and procedure code and modifier combinations being added to the MA Program Fee Schedule, which are advanced radiology services, will require prior authorization under section 443.6(b)(7) of the Human Services Code (code) (62 P.S. § 443.6(b)(7)).

Procedure Codes and Modifiers
78429 78429 (TC) 78429 (26) 78430 78430 (TC)
78430 (26) 78431 78431 (TC) 78431 (26) 78432
78432 (TC) 78432 (26) 78433 78433 (TC) 78433 (26)
78434 78434 (TC) 78434 (26) 78459 78459 (TC)
78459 (26) 78491 78491 (TC) 78491 (26) 78492
78492 (TC) 78492 (26) 78830 78830 (TC) 78830 (26) 
78831 78831 (TC) 78831 (26) 78832 78832 (TC)
78832 (26) 78835 78835 (TC) 78835 (26)

 The following orthodontic procedure codes being added to the MA Program Fee Schedule will require prior authorization under section 443.6(b)(5) of the code:

Procedure Codes
D8703 D8704

Fiscal Impact

 The estimated cost for Fiscal Year (FY) 2020-2021 is $1.705 million ($0.815 million in State funds). The estimated cost for FY 2021-2022 is $2.045 million ($0.977 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, 
Secretary

 Fiscal Note: 14-NOT-1391. (1) General Fund; (2) Implementing Year 2019-20 is $0; (3) 1st Succeeding Year 2020-21 is $815,000; 2nd Succeeding Year 2021-22 through 5th Succeeding Year 2024-25 are $977,000; (4) 2018-19 Program—$342,544,000; 2017-18 Program—$477,690,000; 2016-17 Program—$450,970,000; (7) MA—Fee-for-Service; (8) recommends adoption. There is no fiscal impact in the current fiscal year.

[Pa.B. Doc. No. 20-695. Filed for public inspection May 22, 2020, 9:00 a.m.]


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