NOTICES

DEPARTMENT OF HUMAN SERVICES

Updates to the Medical Assistance Program Fee Schedule: Procedure Codes for the Administration of SARS-CoV-2 Vaccines to Beneficiaries who are Homebound

[51 Pa.B. 5767]
[Saturday, September 4, 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 a procedure code and updates to procedure codes on the Medical Assistance (MA) Program Fee Schedule for the administration of vaccines for the novel coronavirus (SARS-CoV-2).

 The MA Program Fee Schedule is being revised to pay providers $75 per dose to administer SARS-CoV-2 vaccines to MA beneficiaries who are homebound, effective April 1, 2021, through June 7, 2021, subject to the approval of the Centers for Medicare & Medicaid Services (CMS). This rate was developed to account for the additional costs associated with traveling and administering SARS-CoV-2 vaccines to MA beneficiaries who are homebound.

 The Department added pricing modifier AT and place of service 12 (Home) to the following SARS-CoV-2 administration codes to indicate the vaccine was administered to a beneficiary who is homebound.

Vaccine Manufacturer	Code	Code Description	MA Fee
Pfizer, 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	$75
	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	$75
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	$75
	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	$75
Janssen Biotech, Inc.	0031A	Immunization administration by intramuscular injection of severe acute 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	$75

 On June 8, 2021, CMS announced the Medicare program will provide an additional payment of $35 for SARS-CoV-2 vaccines administered to individuals in their homes. This payment will be made in addition to the current $40 SARS-CoV-2 administration fee when the vaccine is administered to an individual in their home. To facilitate this additional payment, CMS established a new procedure code, M0201, to utilize when SARS-CoV-2 vaccines are administered to individuals in their homes. This procedure code was added to the MA Program Fee Schedule, effective for dates of service on and after June 8, 2021.

 The Department updated the MA Program Fee Schedule to include the procedure code for the administration of SARS-CoV-2 vaccines to beneficiaries who are homebound as set forth as follows:

Code	Code Description	MA Fee
M0201	COVID-19 Vaccine Administration at Home	$35

 The Department issued an MA Bulletin to providers enrolled in the MA Program advising of the addition and updates to these procedure codes on the MA Program Fee Schedule.

Fiscal Impact

 The estimated cost for Fiscal Year 2021-2022 is $1.024 million in Total funds for Fee-for-Service.

Public Comment

 Interested persons are invited to submit written comments regarding the change to the MA Program Fee Schedule 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 Secretary

 Fiscal Note: 14-NOT-1445. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 21-1485. Filed for public inspection September 3, 2021, 9:00 a.m.]

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