NOTICES
DEPARTMENT OF HUMAN SERVICES
Medical Assistance Program Fee Schedule Revisions; 2024 Healthcare Common Procedure Coding System Updates; Fee Adjustments; Prior Authorization Requirements
[54 Pa.B. 2905]
[Saturday, May 25, 2024]
The Department of Human Services (Department) announces changes to the Medical Assistance (MA) Program Fee Schedule. These changes are effective for dates of service on and after May 28, 2024.
The Department is adding and end-dating procedure codes as a result of the 2024 updates published by the Centers for Medicare & Medicaid Services to the Healthcare Common Procedure Coding System (HCPCS). The Department is also adding other procedure codes and making changes to procedure codes currently on the MA Program Fee Schedule, to include setting limitations and making fee adjustments. As follows, some of the procedure codes being added to the MA Program Fee Schedule will require prior authorization.
Procedure Codes Being Added or End-dated
The Department is adding the following procedure codes, and procedure code and modifier combinations to the MA Program Fee Schedule as a result of the 2024 HCPCS updates. These procedure codes may include the modifiers SG (ASC/SPU facility support component), RT (right), LT (left), 50 (bilateral), 26 (professional component), FP (family planning) or FQ (audio-only communication technology).
Procedure Codes and Modifiers
|
|---|
| 58580 | 58580 (SG) | 61889 (RT) | 61889 (LT) | 61889 (50) | 61891 (SG) |
| 61891 (RT) | 61891 (LT) | 61891 (50) | 61892 (SG) | 61892 (RT) | 61892 (LT) |
| 61892 (50) | 76984 (26) | 76987 (26) | 76988 (26) | 76989 (26) | 81457 |
| 81458 | 81459 | 81517 | 86041 | 86042 | 86043 |
| 92622 | 92623 | 93584 | 93585 | 93586 | 93587 |
| 93588 | A4287 | D2991 | G0136 | G0136 (FP) | G0136 (FQ) |
The Department is adding the following procedure codes, and procedure code and modifier combinations to the MA Program Fee Schedule as a result of the 2024 HCPCS updates. These procedure codes may include the modifiers RT or LT.
Procedure Codes
|
|---|
| A6520 (RT) | A6520 (LT) | A6522 (RT) | A6522 (LT) | A6524 (RT) | A6524 (LT) |
| A6526 (RT) | A6526 (LT) | A6528 | A6522 (RT) | A6522 (LT) | A6554 (RT) |
| A6554 (LT) | A6566 | A6568 | A6570 | A6572 (RT) | A6572 (LT) |
| A6575 (RT) | A6575 (LT) | A6578 (RT) | A6578 (LT) | A6581 (RT) | A6581 (LT) |
| A6582 (RT) | A6582 (LT) | A6583 (RT) | A6583 (LT) | A6585 (RT) | A6585 (LT) |
| A6586 (RT) | A6586 (LT) | A6587 (RT) | A6587 (LT) | A6588 (RT) | A6588 (LT) |
| A6589 | A6594 (RT) | A6594 (LT) | A6595 (RT) | A6595 (LT) | A6596 |
| A6597 | A6598 | A6599 | A6600 | A6601 | A6602 |
| A6603 | A6604 | A6605 | A6606 | A6607 | A6608 |
The Department is adding the following procedure codes and procedure code and modifier combination to the MA Program Fee Schedule based upon clinical review. These procedure codes may include the modifier SG.
Procedure Codes and Modifiers
|
|---|
| 61886 | 61886 (SG) | 90867 | 90868 | 90869 | 93241 |
| 93245 | 93246 | 93247 | 93248 | A2019 | D0190 |
| D0191 | Q4158 | | | | |
Effective for dates of service on and after January 1, 2024, the Department added the following procedure codes to the MA Program Fee Schedule based upon clinical review.
Procedure Codes
|
|---|
| 87428 | 90694 | |
The Department is end-dating the following procedure codes from the MA Program Fee Schedule as a result of the 2024 HCPCS updates.
Procedure Codes
|
|---|
| 0014M | 74710 | G2066 | K1005 | |
Prior Authorization Requirements
The following procedure codes and procedure code and modifier combination being added to the MA Program Fee Schedule require prior authorization, as authorized under section 443.6(b)(7) of the Human Services Code (Code) (62 P.S. § 443.6(b)(7)), regarding reimbursement of certain medical assistance items and services.
Procedure Codes
|
|---|
| A2019 | Q4158 | |
The dental procedure code D2991 being added to the MA Program Fee Schedule will require prior authorization, as authorized under section 443.6(b)(5) of the Code.
Updates to Procedure Codes Currently on the MA Program Fee Schedule
Physician Services
The Department is adjusting the MA Program fees for the following procedure codes for Provider Type (PT)/Specialty (Spec)/Place of Service (POS) combination 31 (Physician)/All/11 (Office) as indicated as follows.
| Procedure Codes | PT/Spec/POS | Current Fee | New Fee |
|---|
| 93297 | 31/All/11 | $20.64 | $44.94 |
| 93298 | 31/All/11 | $22.86 | $75.06 |
Fiscal Impact
The estimated annualized cost is $10.631 million in total funds.
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, 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,
Secretary
Fiscal Note: 14-NOT-1631. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund; (2) Implementing Year 2023-24 is $0; (3) 1st Succeeding Year 2024-25 through 5th Succeeding Year 2028-29 are $4,800,000; (4) 2022-23 Program—$589,137,000; 2021-22 Program—$644,059,000; 2020-21 Program—$808,350,000; (7) MA—Fee-for-Service; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 24-730. Filed for public inspection May 24, 2024, 9:00 a.m.]
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