NOTICES
DEPARTMENT OF HUMAN SERVICES
Medical Assistance Program Fee Schedule: Addition of Procedure Codes for SARS-CoV-2 Vaccine Administration
[51 Pa.B. 2360]
[Saturday, April 24, 2021]In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Human Services (Department) announces the addition of procedure codes to the Medical Assistance (MA) Program Fee Schedule for the administration of vaccines for the novel coronavirus (SARS-CoV-2).
On November 10, 2020, in anticipation of the availability of vaccines for SARS-CoV-2, the American Medical Association (AMA), in collaboration with the Centers for Medicare & Medicaid Services (CMS), established new Current Procedural Terminology (CPT) codes for the administration of the vaccines manufactured by Pfizer, Inc. and Moderna, Inc. These codes were added to the MA Program Fee Schedule on December 1, 2020.
On December 17, 2020, the AMA, in collaboration with CMS, established new CPT codes for the administration of the SARS-CoV-2 vaccines manufactured by AstraZeneca. These codes were added to the MA Program Fee Schedule on February 1, 2021.
On January 20, 2021, the AMA, in collaboration with CMS, established a new CPT code for the administration of the SARS-CoV-2 vaccines manufactured by Janssen Biotech, Inc. The code was added to the MA Program Fee Schedule on February 26, 2021.
The Department updated the MA Program Fee Schedule to include the CPT codes for the administration of the SARS-CoV-2 vaccines, as set forth as follows.
Vaccine Manufacturer Code Code Description MA
FeePfizer, Inc. 0001A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose $16.94 0002A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose $28.39 Moderna, Inc. 0011A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose $16.94 0012A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose $28.39 AstraZeneca 0021A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage; first dose $16.94 0022A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage; second dose $28.39 Janssen
Biotech, Inc.0031A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5mL dosage; single dose $28.39 The Department also issued MA Bulletins to providers enrolled in the MA Program advising of the addition of the new CPT codes to the MA Fee Schedule.
Fiscal Impact
The estimated fiscal impact of the addition of SARS-CoV-2 vaccine administration for Fee-for-Service for Fiscal Year (FY) 2020-2021 is $3.464 million. The estimated fiscal impact for managed care for FY 2021-2022 is $102.335 million and for Fee-for-Service is $10.495 million.
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 Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days 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 Pennsylvania Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
MEG SNEAD,
Acting SecretaryFiscal Note: 14-NOT-1418. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 21-647. Filed for public inspection April 23, 2021, 9:00 a.m.]
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