NOTICES

DEPARTMENT OF
PUBLIC WELFARE

Medical Assistance Program Fee Schedule Revisions; Deletion of Codes Having Zero Occurrences

[32 Pa.B. 5809]

   The Department of Public Welfare (Department) announces that effective December 1, 2002, changes will be made to the Medical Assistance (MA) Program Fee Schedule to begin to bring the procedure coding system into compliance with Health Insurance Portability and Accountability Act (HIPAA) (Pub. L. No. 104-191, 110 Stat. 1836) requirements. HIPAA requires payors of medical services to use standardized procedure code sets. The HIPAA procedure code sets that have been adopted are:

   *  National Drug Codes (NDC)--Drugs, biologicals.

   *  Current Dental Terminology, third edition (CDT-3)--Dental services.

   *  Current Procedure Terminology, fourth revision (CPT-4)--Physicians and all other services.

   *  CPT-4--HCFA Common Procedure Coding System (HCPCS) Level II--Medical equipment, injectible drugs, transportation services and other services not found in CPT-4.

   The following provides those procedure codes that will be end dated November 30, 2002, due to zero occurrences during 2001.

Contact Person

   A copy of this notice is available for review at local County Assistance Offices. Interested persons are invited to submit written comments to this notice within 30 days of this publication. Comments should be sent to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office, Attention: Regulations Coordinator, Room 515 Health and Welfare Building, Harrisburg, PA 17120. Comments received will be considered for future fee schedule revisions.

   Persons with a disability may use the AT&T Relay Service, (800) 654-5984 (TDD users) or (800) 654-5988 (voice users). Persons who require another alternative should contact the Office of Legal Counsel, (717) 783-2209.

FEATHER O. HOUSTOUN,   
Secretary

Local Procedure Codes Being Deleted from the Fee Schedule as a Result of Zero Occurrences and which will not be Compensable for Services Provided after November 30, 2002

Procedure	Type of
Code	Service	Provider Type	Description
W0090	AJ	01	EPSDT-Screen-Physician
W0091	AJ	10	EPSDT-Screen-Independent clinic
W0092	AJ	01	EPSDT-Screen-Basic hospital clinic
W0093	AJ	11	EPSDT-Screen-Hospital outpatient clinic (enrollment approval required)
W0095	AJ	49	EPSDT-Screen CRNPs
W0190	HS	37	Hospice (drugs)
W0191	HS	37	Respite (Medicare 1-5)
W0192	HS	37	Respite (Medicare 6 or more)
W0400	ES	50	Nonsecure psychiatric care
W0401	ES	50	Secure psychiatric care
W0519	AK	23	Exception to RN/LPN, PT, OT, ST audiologist limits
W0526	AK	23	Audiological therapy (days 1-28) by an audiologist
W0527	AK	23	Audiological therapy (29th day and beyond) by an audiologist
W0609	HS	01	Attending physician direct care--general inpatient care--follow-up must be provided by physician not related to a hospice
W0616	HS	01	Attending physician direct care-inpatient respite care--1-5 visits per 60 days--must be provided by physician not related to a hospice
W0617	ES	50	Program exception--Case Management--Mental Health
W0902	10	01	Declotting of internal A-V shunt anastomosis of graft with or without balloon catheter, artery or vein
W0902	20	01	Declotting of internal A-V shunt anastomosis of graft with or without balloon catheter, artery or vein
W0902	27	06, 08	Declotting of internal A-V shunt anastomosis of graft with or without balloon catheter, artery or vein
W0902	40	01, 44	Declotting of internal A-V shunt anastomosis of graft with or without balloon catheter, artery or vein
W0953	AK	23	Office visit hypodermic/intramuscular therapy
W5947	30	09	Birth center visit, first trimester, physician
W5948	30	09	Birth center visit, second trimester, physician
W9078	CM	02	Case management research code (Initial case management services provided to a client)
W9090	CM	02	Case management services/MA-0192 Waiver (Days 1-30)
W9091	CM	02	Case management services/MA-0192 Waiver (Each 30 day period thereafter)
W9250	80	01, 10, 11, 12	Rotational vestibular testing
W9351	25	01, 11, 12	HIS bundle electrogram; with stress testing
W9352	25	01, 11, 12	HIS bundle electrogram; with drug evaluation
W9352	27	06, 08	HIS bundle electrogram; with drug evaluation
W9353	25	01, 11, 12	HIS bundle electrogram; with tachyarrhythmia study
W9356	25	01, 11, 12	Left cardiac catherization with insertion of transvenous electrode, temporary
W9356	27	06, 08	Left cardiac catherization with insertion of transvenous electrode, temporary
W9417	80	01, 10, 11, 12	Maximal expiratory volume studies
W9417	AY	01	Maximal expiratory volume studies
W9417	AZ	10, 11, 12	Maximal expiratory volume studies
W9418	80	01, 10, 11, 12	Various forced expiratory volume studies, that is FEV1, FEV1%, FEV2, FEV3
W9418	AY	01	Various forced expiratory volume studies, that is FEV1, FEV1%, FEV2, FEV3
W9418	AZ	10, 11, 12	Various forced expiratory volume studies, that is FEV1, FEV1%, FEV2, FEV3
W9594	80	01, 08, 10, 11, 12	Electromyography; including nerve conduction velocities, four extremeties and related parasp.
W9594	AY	01	Electromyography; including nerve conduction velocities, four extremeties and related parasp.
W9594	AZ	08, 10, 11, 12	Electromyography; including nerve conduction velocities, four extremeties and related parasp.
W9869	30	09	General assistance exception--obstetrical office visit
W9874	AR	30	General assistance exception--family planning clinic
W9875	30	01	General assistance exception--obstetrical office visit
W9972	9P	05, 19	Patient vertical positioning device, nonmechanical
X1165	20	01, 04, 10, 11, 12	Debridement of hypertrophic nail; subsequent, single
X2135	27	06, 08	Treatment of closed or open fracture of malar area, including zygomatic arch and malar tripod w/o manipulation
X2135	40	01, 44	Treatment of closed or open fracture of malar area, including zygomatic arch and malar tripod w/o manipulation
X2825	20	01, 04, 10, 11, 12	Tenotomy and/or partial capsulotomy, closed, puncture or snap type, metatarsophalangeal joint
X2825	27	06, 08	Tenotomy and/or partial capsulotomy, closed, puncture or snap type, metatarsophalangeal joint
X2825	40	01, 44	Tenotomy and/or partial capsulotomy, closed, puncture or snap type, metatarsophalangeal joint
X2835	20	01, 04, 10, 11, 12	Arthroplasty of foot; phalangeal-phalangeal joint
X2835	27	06, 08	Arthroplasty of foot, phalangeal-phalangeal joint
X2835	40	01, 44	Arthroplasty of foot, phalangeal-phalangeal joint
X2836	10	01, 04	Arthroplasty of foot; first metatarsophalangeal joint, total joint replacement
X2836	20	01, 04, 10, 11, 12	Arthroplasty of foot, first metatarsophalangeal joint, total joint replacement
X2836	27	06, 08	Arthroplasty of foot, first metatarsophalangeal joint, total joint replacement
X2836	40	01, 44	Arthroplasty of foot, first metatarsophalangeal joint, total joint replacement
X2837	10	01, 04	Arthroplasty of foot; inter-phalangeal joint, with implant
X2837	20	01, 04, 10, 11, 12	Arthroplasty of foot; inter-phalangeal joint, with implant
X2837	27	06, 08	Arthroplasty of foot; inter-phalangeal joint, with implant
X2837	40	01, 44	Arthroplasty of foot; inter-phalangeal joint, with implant
X2838	10	01, 04	Arthroplasty of foot; metatarsal-phalangeal joint, with implant
X2838	20	01, 04, 10, 11, 12	Arthroplasty of foot; metatarsal-phalangeal joint, with implant
X2838	27	06, 08	Arthroplasty of foot; metatarsal-phalangeal joint, with implant
X2838	40	01, 44	Arthroplasty of foot; metatarsal-phalangeal joint, with implant
X3203	20	01, 11, 12	Thoracostomy tube with water seal, for drainage of malignant pleural effusion
X3203	40	01, 04	Thoracostomy tube with water seal, for drainage of malignant pleural effusion
X3553	10	01	Bypass graft, axillary-brachial
X3553	20	01	Bypass graft, axillary-brachial
X3553	27	06, 08	Bypass graft, axillary-brachial
X3553	40	01, 44	Bypass graft, axillary-brachial
X3626	25	01, 11, 12	Implantation of an infusion pump with catheterization hepatic artery by lararotomy
X3626	40	01, 44	Implantation of an infusion pump with catheterization hepatic artery by lararotomy
X3633	10	01	Percutaneous transluminal angioplasty; coronary artery (includes pre and post injections for angiography and cardiac catherization)
X3633	20	01, 11, 12	Percutaneous transluminal angioplasty; coronary artery (includes pre and post injections for angiography and cardiac catherization)
X3633	27	06, 08	Percutaneous transluminal angioplasty; coronary artery (includes pre and post injections for angiography and cardiac catherization)
X3633	40	01, 44	Percutaneous transluminal angioplasty; coronary artery (includes pre and post injections for angiography and cardiac catherization)
X3634	10	01	Catheterization of coronary artery with thrombolytic agent for recanalization (includes pre and post injections for angiography and cardiac catheterization)
X3634	20	01, 11, 12	Cauterization of coronary artery with thrombolytic agent for recanalization (includes pre and post injections for angiography and cardiac catheterization)
X3634	27	06, 08	Cauterization of coronary artery with thrombolytic agent for recanalization (includes pre and post injections for angiography and cardiac catheterization)
X3634	40	01, 44	Cauterization of coronary artery with thrombolytic agent for recanalization (includes pre and post injections for angiography and cardiac catheterization)
X3635	10	01	Percutaneous transluminal angioplasty; each additional vessel, eg, coronary, visceral, peripheral
X3635	20	01, 11, 12	Percutaneous transluminal angioplasty; each additional vessel, eg, coronary, visceral, peripheral
X3635	40	01, 44	Percutaneous transluminal angioplasty; each additional vessel, eg, coronary, visceral, peripheral
X3659	10	01	Transluminal peripheral atherectomy, percutaneous; each additional vessel, eg, coronary, visceral and peripheral
X3659	20	01	Transluminal peripheral atherectomy, percutaneous; each additional vessel, eg, coronary, visceral and peripheral
X3659	40	01, 44	Transluminal peripheral atherectomy, percutaneous; each additional vessel, eg, coronary, visceral and peripheral
X3823	10	01	Bone marrow harvesting for transplantation, autologous
X3823	20	01	Bone marrow harvesting for transplantation, autologous
X3823	40	01, 44	Bone marrow harvesting for transplantation, autologous
X4320	25	01, 10, 11, 12	Suction esophageal biopsy
X4320	40	01, 44	Suction esophageal biopsy
X4530	25	01, 10, 11, 12	Proctosigmoidoscopy; routine service, asymptomatic patient
X4530	40	01, 44	Proctosigmoidoscopy; routine service, asymptomatic patient
X4533	25	01, 10, 11, 12	Sigmoidoscopy, flexible fiberoptic; asymptomatic patient
X4533	40	01, 44	Sigmoidoscopy, flexible fiberoptic; asymptomatic patient
X5812	10	01	Vaginal hysterectomy; with plastic repair of vagina, anterior and/or posterior colporrhaphy
X5812	20	01	Vaginal hysterectomy; with plastic repair of vagina, anterior and/or posterior colporrhaphy
X5812	40	01, 44	Vaginal hysterectomy; with plastic repair of vagina, anterior and/or posterior colporrhaphy
X5888	20	01	Laparoscopy, with fulguration of oviducts and D&C (dilation and curettage)
X5888	27	06, 08	Laparoscopy, with fulguration of oviducts and D&C (dilation and curettage)
X5888	40	01, 44	Laparoscopy, with fulguration of oviducts and D&C (dilation and curettage)
X5900	25	01	Percutaneous umbilical blood sampling (PUBS)
X5902	25	01	Nipple stimulation stress test
X5982	10	01	Abortion (elective); transabdominal approach
X5982	30	01	Abortion (elective); transabdominal approach
X5982	40	01, 44	Abortion (elective); transabdominal approach
X6378	10	01	Subcutaneous implantation of infusion pump with catheterization for connection to intraspinal catheter (eg, epidural, intrathecal subarachnold)
X6378	20	01	Subcutaneous implantation of infusion pump with catheterization for connection to intraspinal catheter (eg, epidural, intrathecal subarachnold)
X6378	40	01, 44	Subcutaneous implantation of infusion pump with catheterization for connection to intraspinal catheter (eg, epidural, intrathecal subarachnold)
X6680	20	01, 10, 11, 12	Discission of lens, needling of secondary membrane, complicated, as scissors
X6680	27	06, 08	Discission of lens, needling of secondary membrane, complicated, as scissors
X6680	40	01, 44	Discission of lens, needling of secondary membrane, complicated, as scissors
Y0704	54	01, 08, 10, 11, 12	Arthrography, lumbar facet joint
Y0704	57	01	Arthrography, lumbar facet joint
Y0704	RD	08, 10, 11, 12	Arthrography, lumbar facet joint
Y2600	10	01	HIP arthroscopy
Y2600	20	01	HIP arthroscopy
Y2600	27	06, 08	HIP arthroscopy
Y2600	40	01, 44	HIP arthroscopy
Y7033	54	01, 10, 11, 12	Magnetic resonance (eg, proton) imaging, temporomandibular joint; with contrast material
Y7033	57	01	Magnetic resonance (eg, proton) imaging, temporomandibular joint; with contrast material
Y7033	RD	08, 10, 11, 12	Magnetic resonance (eg, proton) imaging, temporomandibular joint; with contrast material
Y7034	54	01, 10, 11, 12	Magnetic resonance (eg, proton) imaging, temporomandibular joint; without contrast material, followed by contrast material
Y7034	57	01	Magnetic resonance (eg, proton) imaging, temporomandibular joint; without contrast material, followed by contrast material
Y7034	RD	08, 10, 11, 12	Magnetic resonance (eg, proton) imaging, temporomandibular joint; without contrast material, followed by contrast material
Y7210	54	01, 10, 11, 12	Radiology diagnostic, lumbar spine and pelvis; limited anteroposterior and lateral views of spine with anteroposterior view of pelvis
Y7210	57	01	Radiology diagnostic, lumbar spine and pelvis; limited anteroposterior and lateral views of spine with anteroposterior view of pelvis
Y7210	RD	08, 10, 11, 12	Radiology diagnostic, lumbar spine and pelvis; limited anteroposterior and lateral views of spine with anteroposterior view of pelvis
Y7427	54	01, 10, 11, 12	Radiologic examination, colon; air contrast barium enema-asymptomatic patient
Y7427	57	01	Radiologic examination, colon; air contrast barium enema-asymptomatic patient
Y7427	RD	10, 11, 12	Radiologic examination, colon; air contrast barium enema-asymptomatic patient
Y7540	54	01, 08, 10, 11, 12	Angiography, digital subtraction; simple (maximum 2 runs)
Y7540	57	01	Angiography, digital subtraction; simple (maximum 2 runs)
Y7540	RD	08, 10, 11, 12	Angiography, digital subtraction; simple (maximum 2 runs)
Y7541	54	01, 08, 10, 11, 12	Angiography, digital, subtraction; intermediate (maximum 4 runs)
Y7541	57	01	Angiography, digital, subtraction; intermediate (maximum 4 runs)
Y7541	RD	08, 10, 11, 12	Angiography, digital, subtraction; intermediate (maximum 4 runs)
Y7542	54	01, 08, 10, 11, 12	Angiography, digital subtraction; complex (more than 4 runs)
Y7542	57	01	Angiography, digital subtraction; complex (more than 4 runs)
Y7542	RD	08, 10, 11, 12	Angiography, digital subtraction; complex (more than 4 runs)
Y7556	54	01, 10, 11, 12	Magnetic resonance (eg, proton) imaging, myocardium; without contrast material, followed by contrast material
Y7556	57	01	Magnetic resonance (eg, proton) imaging, myocardium; without contrast material, followed by contrast material
Y7556	RD	10, 11, 12	Magnetic resonance (eg, proton) imaging, myocardium; without contrast material, followed by contrast material
Y7640	54	01, 10, 11, 12	Magnetic resonance (eg, proton) imaging, bone marrow blood supply; with contrast material
Y7640	57	01	Magnetic resonance (eg, proton) imaging, bone marrow blood supply; with contrast material
Y7640	RD	10, 11, 12	Magnetic resonance (eg, proton) imaging, bone marrow blood supply; with contrast material
Y7641	54	01, 10, 11, 12	Magnetic resonance (eg, proton) imaging, bone marrow blood supply; without contrast material, followed by contrast material
Y7641	57	01	Magnetic resonance (eg, proton) imaging, bone marrow blood supply; without contrast material, followed by contrast material
Y7641	RD	10, 11, 12	Magnetic resonance (eg, proton) imaging, bone marrow blood supply; without contrast material, followed by contrast material
Y7694	57	01	Ultrasonic guidance for percutaneous umbilical blood sampling (PUBS); supervision and interpretation only
Y7695	54	01, 08, 10, 11, 12	Ultrasonic guidance for percutaneous umbilical blood sampling (PUBS); complete procedure
Y7770	50	01, 11	Radioisotope dosimetry and interpretation of application
Y7770	51	01	Radioisotope dosimetry and interpretation of application
Y7770	RT	11	Radioisotope dosimetry and interpretation of application
Y9653	AE	05, 19	Central venous catheter repair kit
Y9936	AE	05, 19	Airway pressure manometer
Z0042	9R	05, 19	Stationary compressed gas system rental, includes contents (per unit), regulator with flow gauge, humidifier, nebulizer, cannula or mask and tubing, 1 unit=50 cubic feet (less than 1 lpm)
Z0131	9P	05, 19	Walk aid-rigid with balance ring
Z0131	9R	05, 19	Walk aid-rigid with balance ring
Z0132	9P	05, 19	Walk aid-Walkamatic (reciprocal)
Z0462	9P	05, 19	Regulator (replacement)
Z0519	9P	05, 19	Jar and lid (replacement accessory-volume ventilator portable)
Z0542	9P	05, 19	Supporting grid (accessory-negative pressure)
Z0543	9P	05, 19	Backplate (accessory-negative pressure)
Z0545	9P	05, 19	Hose for chest shell or pullover (accessory-negative pressure)
Z0546	9P	05, 19	Pneumobelt (accessory-volume ventilator)
Z0547	9P	05, 19	Bladder (accessory-volume ventilator)
Z0548	9P	05, 19	Pneumobelt hose to ventilator (accessory-volume ventilator)
Z0882	9P	05, 19	Buck's extension with weights
Z0883	9P	05, 19	Weights for traction set-up to 25 lbs (water)
Z0937	9P	05, 19	Wrist device (dynasplint)
Z0937	9R	05, 19	Wrist device (dynasplint)
Z1000	9P	05, 19	Semi-pneumatic caster and wheel assembly, each
Z1405	9R	05, 19	Oxygen concentrator, manufacturer specified maximum flow greater than 5 liters per minute, at 85% or greater concentration (less than 1 lpm)
Z1407	9P	05, 19	Transtracheal catheter with cleaning rod
Z1409	9P	05, 19	Transtracheal cleaning rods (replacement)
Z1410	9P	05, 19	Transtracheal catheter wire guide
Z1411	9P	05, 19	Transtracheal bead chain necklace
Z1412	9R	05, 19	Oxygen and water vapor enriching system with heated delivery (less than 1 lpm)
Z1413	9R	05, 19	Oxygen and water vapor enriching system with heated delivery (more than 4 lpm)
Z1414	9R	05, 19	Oxygen and water vapor enrighing system without heated delivery (less than 1 lpm)
Z1415	9R	05, 19	Oxygen and water vapor enriching system without heated delivery (more than 4 lpm)
Z1605	AM	05, 19	Hip orthosis, ponsetta bar, knee pad
Z1640	AM	05, 19	Hip orthosis, unilateral, pelvic band and belt, hip joint trochanter bar, thigh band and cuff for abduction
Z2121	AM	05, 19	Ankle foot orthosis, tibial (Sarmiento, removable orthoplast)
Z3061	AM	05, 19	Arch support, metal, each
Z3987	AM	05, 19	Humeral orthosis, forearm and humeral orthoplast free motion elbow joints (removable)
Z3988	AM	05, 19	Humeral orthosis, forearm and humeral orthoplast free motion elbow joints (removable)
Z5231	9S	05, 19	Above knee prosthesis, modular quadrilateral plastic total contact with hip joint, single axis
Z5241	9S	05, 19	Patellar tendon bearing prosthesis, modular plastic socket, soft closed end insert socket liner, each foot, cuff suspension, foam cover
Z5243	9S	05, 19	Supracondylar patellar tendon bearing prosthesis, plastic socket, soft closed end insert socket linen or condylar wedge, each foot
Z5244	9S	05, 19	Supracondylar patellar tendon bearing prosthesis, modular plastic socket, soft insert or hard socket or condylar wedge, foam cover and each foot
Z6003	9B	05, 11	Factor-VIII, dry heat; per 100 international units
Z6005	9B	05, 11	Cryoprecipitate, double bag
Z6101	9S	05, 19	Below elbow prosthesis, wrist disarticulation, plastic socket, friction manual wrist unit
Z6102	9S	05, 19	Below elbow prosthesis, plastic double wall socket, single pivot joints, friction manual wrist unit, below elbow figure-eight or ring single control flexible hinges and triceps pad
Z6866	9S	05, 19	Cosmetic partial hand appliance with glove (zipper or no zipper)
Z7606	9S	05, 19	Above elbow ring harness (including fitting)
Z9009	AE	05, 19, 23	Pediatric tracheostomy metal swivel
Z9888	ES	50	Medical case management

[Pa.B. Doc. No. 02-2105. Filed for public inspection November 22, 2002, 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.

---