NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Medical Assistance Program Fee Schedule Revisions; National Procedure Codes for Ambulance Services
[34 Pa.B. 6609] The purpose of this notice is to announce that National Procedure Codes and Modifiers for Ambulance Services (National Codes) will replace local procedure and type of service codes on the Medical Assistance (MA) Program Fee Schedule. Adoption of National Codes will make procedure codes used in the MA Program consistent with the codes used by all other third-party payors. The National Codes will be effective for dates of service on and after November 1, 2004. The use of local codes will ended effective October 31, 2004.
The following procedure codes will be added to the MA Program Fee Schedule for dates of service on and after November 1, 2004:
New Procedure Code Definition A0425 Ground mileage, per statute mile A0435 Fixed wing air mileage, per statute mile A0436 Rotary wing air mileage, per statute mile A0428 Ambulance service, basic life support, nonemergency transport (BLS) A0429 Ambulance service, basic life support, emergency transport (BLS-emergency) A0426 Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1) A0427 Ambulance service, advanced life support, emergency transport, level 1 (ALS 1-emergency) A0430 Ambulance service, conventional air services, transport, one way (fixed wing) A0431 Ambulance service, conventional air services, transport, one way (rotary wing) A0433 Advanced life support, level 2 (ALS 2) A0432 Paramedic intercept (PI), rural area, transport furnished by a volunteer ambulance company which is prohibited by State law from billing third party payers A0434 Specialty care transport (SCT) The following procedure codes will be deleted from the MA Program Fee Schedule and will not be compensable for services provided after October 31, 2004.
Procedure
CodeDefinition W0009 Non-VASC Certified Nonemergency transportation service, other unusual circumstances W0010 Non-VASC Certified Nonemergency transportation service W0011 Each loaded or unloaded mile beyond the first 20 miles of a round trip W0012 VASC Certified Nonemergency transportation service W0013 VASC Certified Nonemergency transportation service, other unusual circumstances W0014 Non-VASC Certified ambulance emergency (prehospital) transportation service W0015 VASC Certified ambulance emergency (prehospital) transportation service W0016 Advanced Life Support (ALS) with transportation (prehospital) W0017 Advanced Life Support (ALS) without transportation (prehospital) W0018 Specialized Services Critical Care with transport, interfacility cases of neonatal, prenatal or cardiac service W8593 Transportation, air ambulance: program exception code The Department of Public Welfare (Department) will issue a MA Bulletin to affected service providers which sets forth the crosswalk from local to National Codes as well as the fee for each National Code.
Fiscal Impact
There is no fiscal impact as a result of these changes.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department at the following address: Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office: Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received will be considered in subsequent revisions to the fee schedule.
Persons with a disability may use the AT&T Relay Service by calling (800) 654-5984 (TDD Users) or (800) 654-5988 (Voice Users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-401; (8) recommends adoption.
[Pa.B. Doc. No. 04-2202. Filed for public inspection December 10, 2004, 9:00 a.m.]
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