NOTICES
DEPARTMENT OF HUMAN SERVICES
Medical Assistance Program Fee Schedule Updates for Certain Family Planning Procedure Codes
[54 Pa.B. 5682]
[Saturday, September 7, 2024]In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Human Services (Department) announces the following updates to the Family Planning Services Program Fee Schedule, effective for dates of service on and after July 1, 2024.
Discussion
The Department is adjusting fees for services on the Family Planning Services Program Fee Schedule for Family Planning Services providers. These procedure codes may include the modifiers FP (family planning) or U7 (pricing).
Procedure
CodeNational Code Description Modifier
Former
MA FeeNew MA
Fee11981 Insertion, drug-delivery implant (for example, bioresorbable, biodegradable, nonbiodegradable) FP $103.91 $358.81 11982 Removal, nonbiodegradable drug delivery implant FP $126.20 $126.75 11983 Removal with reinsertion, nonbiodegradable drug delivery implant FP $219.10 $382.51 58300 Insertion of intrauterine device (IUD) FP $67.60 $366.78 58301 Removal of IUD FP $84.25 $174.03 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history or examination, or both, and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. FP $62.20 $92.07 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history or examination, or both, and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. FP $95.13 $174.72 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history or examination, or both, and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. FP $31.15 $70.58 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history or examination, or both, and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. U7; FP $31.15 $70.58 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history or examination, or both, and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. FP $63.14 $116.48 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history or examination, or both, and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. FP $96.91 $141.33 99385 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions and the ordering of laboratory/diagnostic procedures, new patient; 18—39 years FP $121.14 $144.58 99386 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions and the ordering of laboratory/diagnostic procedures, new patient; 40—64 years FP $147.46 $167.09 Fiscal Impact
The estimated cost for Fiscal Year 2024-2025 is $3.346 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 at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
VALERIE A. ARKOOSH,
SecretaryFiscal Note: 14-NOT-1646. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund;
(7) Medical Assistance (MA)—Fee-for-Service; (2) Implementing Year 2024-25 is $17,000; (3) 1st Succeeding Year 2025-26 through 5th Succeeding Year 2029-30 are $17,000; (4) 2023-24 Program—$697,354,000; 2022-23 Program—$589,137,000; 2021-22 Program—$644,059,000;
(7) MA—Capitation; (2) Implementing Year 2024-25 is $318,000; (3) 1st Succeeding Year 2025-26 through 5th Succeeding Year 2029-30 are $318,000; (4) 2023-24 Program—$3,594,000,000; 2022-23 Program—$3,418,000,000; 2021-22 Program—$4,557,000,000;
(8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 24-1269. Filed for public inspection September 6, 2024, 9:00 a.m.]
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