NOTICES
DEPARTMENT OF HUMAN SERVICES
Medical Assistance Program Fee Schedule; Addition of Procedure Code for the Dispensing of Oral Antiviral Treatments with Emergency Use Authorization from the United States Food and Drug Administration for Treatment of SARS-CoV-2 (COVID-19)
[52 Pa.B. 1074]
[Saturday, February 12, 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 a procedure code to the Medical Assistance (MA) Program Fee Schedule.
The United States Food and Drug Administration (FDA) recently issued an emergency use authorization (EUA) for oral antiviral medications for the treatment of COVID-19 for Pfizer's Paxlovid (nirmatrelvir tablets and ritonavir tablets, copackaged for oral use) on December 22, 2021, and for Merck's molnupiravir capsules on December 23, 2021. To allow payment to pharmacies for the dispensing to MA beneficiaries of these and any other oral antiviral treatments for SARS-CoV-2 (COVID-19) with EUA from the FDA, the Department added a procedure code to the MA Program Fee Schedule, effective December 22, 2021.
The Department updated the MA Program Fee Schedule to include the Current Procedural Terminology (CPT) code for the dispensing of oral antiviral treatments with EUA from the FDA for the treatment of COVID-19, as set forth as follows.
Procedure Code Procedure Code Description MA Fee Limits S5001 Prescription Drug, Brand $10 1 per day The Department issued an MA Bulletin to providers enrolled in the MA Program advising of the addition of the new CPT code to the MA Program Fee Schedule.
Fiscal Impact
The estimated cost for Fiscal Year 2021-2022 is $0.018 million in total (State and Federal) 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 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-1495. (1) General Fund; (2) Implementing Year 2021-22 is $7,000; (3) 1st Succeeding Year 2022-23 through 5th Succeeding Year 2026-27 are $0; (4) 2020-21 Program—$808,350,000; 2019-20 Program—$344,107,000; 2018-19 Program—$342,544,000; (7) MA—Fee-for-Service; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 22-245. Filed for public inspection February 11, 2022, 9:00 a.m.]
No part of the information on this site may be reproduced for profit or sold for profit.This material has been drawn directly from the official Pennsylvania Bulletin full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
