NOTICES

DEPARTMENT OF HUMAN SERVICES

Addition of COVID-19 Antigen Laboratory Test Codes to the Medical Assistance Program Fee Schedule

[51 Pa.B. 3556]
[Saturday, June 26, 2021]

 The Department of Human Services (Department) announces the addition of two coronavirus (COVID-19) antigen laboratory test codes to the Medical Assistance (MA) Program Fee Schedule, effective with dates of service on and after November 2, 2020.

Background

 On May 9, 2020, the United States Food and Drug Administration announced the first emergency use authorization for a COVID-19 rapid antigen test, a new category of tests for the use in the ongoing COVID-19 public health emergency. These tests are authorized for use in various laboratory settings certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) (42 U.S.C.A. § 263a), that meet the requirements to perform high, moderate or waived complexity tests. Antigen tests were developed for use at the Point of Care, that is, in patient care settings operating under a CLIA Certificate of Waiver, Certificate of Compliance or Certificate of Accreditation.

Procedure Codes Being Added

 The Department is adding the following procedure codes, and procedure code and modifier combinations, to the MA Program Fee Schedule, effective with dates of service on and after November 2, 2020:

Procedure Code	Procedure Code Description	Provider  Type/Specialty	Place of  Service/Modifier	MA Fee	Limits	Prior  Authorization  Required
87426	Infectious agent antigen detection by immunoassay technique, (for example, enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA), fluorescence immunoassay (FIA), immunochemiluminometric assay (IMCA)) qualitative or semi-quantitative; severe acute respiratory syndrome coronavirus (for example, SARS-CoV, SARSCoV-2 (COVID-19))	01/016 01/016 01/017 01/017 01/183 01/183 08/082 08/082 09/All 09/All 28/280 28/280 31/All 31/All 33/335 33/335	23 23/QW 23 23/QW 22 22/QW 49 49/QW 11 11/QW 81 81/QW 11 11/QW 11 11/QW	$34.94	1:1	No
87811	Infectious agent antigen detection by immunoassay with direct optical (that is, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19))	01/016 01/016 01/017 01/017 01/183 01/183 08/082 08/082 09/All 09/All 28/280 28/280 31/All 31/All 33/335 33/335	23 23/QW 23 23/QW 22 22/QW 49 49/QW 11 11/QW 81 81/QW 11 11/QW 11 11/QW	$11.51	1:1	No

Fiscal Impact

 The Department has determined that there is no fiscal impact for the addition of these codes to the MA Program Fee Schedule.

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 Hamilton Relay Service (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

MEG SNEAD, 
Acting Secretary

 Fiscal Note: 14-NOT-1447. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 21-1003. Filed for public inspection June 25, 2021, 9:00 a.m.]

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