NOTICES

DEPARTMENT OF HUMAN SERVICES

Medical Assistance Program Fee Schedule Addition

[52 Pa.B. 2191]
[Saturday, April 9, 2022]

 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 two procedure codes to the Medical Assistance (MA) Program Fee Schedule for use in laboratory testing for multiple respiratory pathogens, including SARS-CoV-2 (COVID-19), effective with dates of service on and after March 21, 2022.

Fee Schedule Addition

 The Department is adding the following procedure codes to the MA Program Fee Schedule as follows:

Procedure Code	Procedure Code Description	Provider Type/ Specialty	Place of Service/ Modifier	MA Fee	Limits	Prior Authorization Required
87636	Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19)) and influenza virus types A and B, multiplex amplified probe technique	01/016 01/016 01/017 01/017 01/183 01/183 08/082 08/082 09/All 09/All 10/100 10/100 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 11 11/QW 81 81/QW 11 11/QW 11 11/QW	$112.86 per test	1 test per day	No
87637	Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19)), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique	01/016 01/016 01/017 01/017 01/183 01/183 08/082 08/082 09/All 09/All 10/100 10/100 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 11 11/QW 81 81/QW 11 11/QW 11 11/QW	$112.86 per test	1 test per day	No

Fiscal Impact

 There is no fiscal impact associated with this notice.

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 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 at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

MEG SNEAD, 
Acting Secretary

 Fiscal Note: 14-NOT-1503. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 22-533. Filed for public inspection April 8, 2022, 9:00 a.m.]

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