NOTICES
DEPARTMENT OF HUMAN SERVICES
Addition of Interprofessional Consultation Services to the Medicaid State Plan and Medical Assistance Program Fee Schedule
[53 Pa.B. 7812]
[Saturday, December 16, 2023]The Department of Human Services (Department) announces the addition of interprofessional consultation services to the Medical Assistance (MA) Program Fee Schedule. These changes are effective for dates of service on and after January 1, 2024.
Discussion
On January 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued State Health Official Letter # 23-001 ''Coverage and Payment of Interprofessional Consultation in Medicaid and the Children's Health Insurance Program.'' In this letter, CMS issued guidance to allow for coverage and payment of interprofessional consultation services when the beneficiary is not present, and the consultation is for the direct benefit of the beneficiary. CMS' previous policy prohibited coverage and payment of provider-to-provider consultation as a distinct service.
In response to CMS' change in policy, the Department will provide coverage and payment for interprofessional consultation services in the MA Program. In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department announces the addition of the following interprofessional consultation service procedure codes to the MA Program Fee Schedule, effective January 1, 2024.
Procedure Code National Code Description MA Fee 99446 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional;
5—10 minutes of medical consultative discussion and review$14.01 99447 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional;
11—20 minutes of medical consultative discussion and review$27.78 99448 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional;
21—30 minutes of medical consultative discussion and review$42.30 99449 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional;
31 minutes or more of medical consultative discussion and review$42.30 99451 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a written report to the patient's treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative discussion and review $42.30 99452 Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes $26.03 The Department will issue an MA Bulletin to inform providers enrolled in the MA Program of the addition of the procedure codes for interprofessional consultation services.
Fiscal Impact
There is minimal fiscal impact associated with the addition of these procedure codes.
Public Comment
Interested persons are invited to submit written comments to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120 or at RA-PWMAProgComments@ pa.gov. Comments received within 30 days 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).
VALERIE A. ARKOOSH,
SecretaryFiscal Note: 14-NOT-1603. No fiscal impact; recommends adoption.
[Pa.B. Doc. No. 23-1733. Filed for public inspection December 15, 2023, 9:00 a.m.]
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