NOTICES

DEPARTMENT OF HUMAN SERVICES

Medical Assistance Program Fee Schedule Updates for Ophthalmology Services

[54 Pa.B. 5919]
[Saturday, September 14, 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 Medical Assistance (MA) Program Fee Schedule for ophthalmology services, effective for dates of service on and after September 15, 2024.

Discussion

 The Department is making changes to the MA Program Fee Schedule as follows:

Procedure Code	National Code Description	Modifier	Current MA Fee	New MA Fee
67312	Strabismus surgery, recession or resection procedure; 2 horizontal muscles		$483.50	$631.24
67316	Strabismus surgery, recession or resection procedure; 2 or more vertical muscles (excluding superior oblique)		$483.50	$677.02
67318	Strabismus surgery, any procedure, superior oblique muscle		$483.50	$654.49
67335	Placement of adjustable sutures during strabismus surgery, including postoperative adjustments of sutures (list separately in addition to code for specific strabismus surgery)		$122.87	$177.55
67343	Release of extensive scar tissue without detaching extraocular muscle (separate procedure)		$118.50	$638.92
68815	Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent		$158.50	$210.82
92002	Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient		$28.34	$43.49
92018	Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete		$39.50	$132.89
92019	Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; limited		$20.50	$69.52
92020	Gonioscopy (separate procedure)		$16	$19.41
92025	Computerized corneal topography, unilateral or bilateral, with interpretation and report		$21.94	$34.48
92025	Computerized corneal topography, unilateral or bilateral, with interpretation and report	TC	$9.01	$16.04
92025	Computerized corneal topography, unilateral or bilateral, with interpretation and report	26	$12.93	$18.44
92060	Sensorimotor examination with multiple measurements of ocular deviation (for example, restrictive or paretic muscle with diplopia) with interpretation and report (separate procedure)		$33.74	$60.61
92060	Sensorimotor examination with multiple measurements of ocular deviation (for example, restrictive or paretic muscle with diplopia) with interpretation and report (separate procedure)	TC	$11.59	$25.30
92060	Sensorimotor examination with multiple measurements of ocular deviation (for example, restrictive or paretic muscle with diplopia) with interpretation and report (separate procedure)	26	$22.15	$35.31
92065	Orthoptic training; performed by a physician or other qualified health care professional		$24.06	$32.27
92081	Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (for example, tangent screen, Autoplot, arc perimeter or single stimulus level automated test, such as Octopus 3 or 7 equivalent)		$28	$31.59
92081	Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (for example, tangent screen, Autoplot, arc perimeter or single stimulus level automated test, such as Octopus 3 or 7 equivalent)	TC	$14.15	$16.35
92081	Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (for example, tangent screen, Autoplot, arc perimeter or single stimulus level automated test, such as Octopus 3 or 7 equivalent)	26	$13.85	$15.24
92082	Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (for example, at least 2 isopters on Goldmann perimeter or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33)		$35	$44.48
92082	Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (for example, at least 2 isopters on Goldmann perimeter or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33)	TC	$18.69	$24.69
92082	Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (for example, at least 2 isopters on Goldmann perimeter or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33)	26	$16.31	$19.79
92132	Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral		$28.42	$29.73
92132	Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral	TC	$11.76	$14.19
92132	Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral	26	$16.66	$15.54
92134	Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina		$34.84	$38.43
92134	Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina	TC	$11.76	$14.81
92134	Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina	26	$23.08	$23.62
92136	Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation		$36.39	$44.82
92136	Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation	TC	$12.90	$16.05
92136	Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation	26	$23.49	$28.77
92201	Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (for example, for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral		$18.33	$21.65
92202	Ophthalmoscopy, extended; with drawing of optic nerve or macula (for example, for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral		$11.84	$13.90
92227	Imaging of retina for detection or monitoring of disease; with remote clinical staff review and report, unilateral or bilateral		$8.90	$16.35
92228	Imaging of retina for detection or monitoring of disease; with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral		$23.33	$28.24
92228	Imaging of retina for detection or monitoring of disease; with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral	TC	$9.67	$12.34
92228	Imaging of retina for detection or monitoring of disease; with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral	26	$13.66	$15.90
92229	Imaging of retina for detection or monitoring of disease; point-of-care autonomous analysis and report, unilateral or bilateral		$35.34	$37.95
92230	Fluorescein angioscopy with interpretation and report		$10	$32.93
92242	Fluorescein angiography and indocyanine-green angiography (includes multiframe imaging) performed at the same patient encounter with interpretation and report, unilateral or bilateral		$173.34	$262.43
92242	Fluorescein angiography and indocyanine-green angiography (includes multiframe imaging) performed at the same patient encounter with interpretation and report, unilateral or bilateral	TC	$129.41	$211.06
92242	Fluorescein angiography and indocyanine-green angiography (includes multiframe imaging) performed at the same patient encounter with interpretation and report, unilateral or bilateral	26	$43.93	$51.37
92265	Needle oculoelectromyography, 1 or more extraocular muscles, 1 or both eyes, with interpretation and report		$48	$82.51
92265	Needle oculoelectromyography, 1 or more extraocular muscles, 1 or both eyes, with interpretation and report	TC	$28.80	$39.19
92265	Needle oculoelectromyography, 1 or more extraocular muscles, 1 or both eyes, with interpretation and report	26	$19.20	$43.32
92270	Electro-oculography with interpretation and report		$77.87	$110.58
92270	Electro-oculography with interpretation and report	TC	$38.48	$70.35
92270	Electro-oculography with interpretation and report	26	$39.39	$40.23
92273	Electroretinography (ERG), with interpretation and report; full field (that is, ffERG, flash ERG, Ganzfeld ERG)		$103.34	$118.32
92273	ERG, with interpretation and report; full field (that is, ffERG, flash ERG, Ganzfeld ERG)	TC	$73.43	$83.94
92273	ERG, with interpretation and report; full field (that is, ffERG, flash ERG, Ganzfeld ERG)	26	$29.91	$34.38
92274	ERG, with interpretation and report; multifocal (mfERG)		$70.26	$84.18
92274	ERG, with interpretation and report; multifocal (mfERG)	TC	$43.74	$52.77
92274	Electroretinography (ERG), with interpretation and report; multifocal (mfERG)	26	$26.52	$31.41
92283	Color vision examination, extended, for example, anomaloscope or equivalent		$11.70	$50.71
92283	Color vision examination, extended, for example, anomaloscope or equivalent	TC	$3.54	$42.58
92283	Color vision examination, extended, for example, anomaloscope or equivalent	26	$8.16	$8.13
92285	External ocular photography with interpretation and report for documentation of medical progress (for example, close-up photography, slit lamp photography, goniophotography, stereo-photography)		$13.25	$21.72
92285	External ocular photography with interpretation and report for documentation of medical progress (for example, close-up photography, slit lamp photography, goniophotography, stereo-photography)	TC	$9.22	$18.82
92285	External ocular photography with interpretation and report for documentation of medical progress (for example, close-up photography, slit lamp photography, goniophotography, stereo-photography)	26	$4.03	$2.90
92286	Anterior segment imaging with interpretation and report; with specular microscopy and endothelial cell analysis		$33.00	$37.07
92286	Anterior segment imaging with interpretation and report; with specular microscopy and endothelial cell analysis	TC	$19.80	$16.66
92286	Anterior segment imaging with interpretation and report; with specular microscopy and endothelial cell analysis	26	$13.20	$20.41

Fiscal Impact

 The estimated impact for Fiscal Year 2024-2025 is $0.965 million in total funds. The estimated annualized cost is $1.655 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 revision of 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, 
Secretary

 Fiscal Note: 14-NOT-1645. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund;

 (7) MA—Fee-for-Service; (2) Implementing Year 2024-25 is $25,000; (3) 1st Succeeding Year 2025-26 through 5th Succeeding Year 2029-30 are $42,000; (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 $408,000; (3) 1st Succeeding Year 2025-26 through 5th Succeeding Year 2029-30 are $690,000; (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. 24-1305. Filed for public inspection September 13, 2024, 9:00 a.m.]

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