NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Medical Assistance Program Fee Schedule Revisions; 2007 Power Mobility HCPCS Updates; Prior Authorization Requirements
[37 Pa.B. 5093]
[Saturday, September 15, 2007]The Department of Public Welfare (Department) announces changes to the Medical Assistance (MA) Program Fee Schedule and accompanying prior authorization requirements.
Fee Schedule Revisions
The Department is adding and end-dating procedure codes as a result of implementing the 2007 power mobility device procedure code updates made by the Centers for Medicare and Medicaid Services (CMS) to the Healthcare Common Procedure Coding System (HCPCS). The 2007 power mobility device HCPCS procedure codes are effective for dates of service on and after September 24, 2007.
Fees for the new power mobility device procedure codes will be published in an MA bulletin that will be issued to providers who prescribe and supply power mobility devices.
The 2007 power mobility device HCPCS procedure codes being added to the MA Program Outpatient Fee Schedule are as follows:
Procedure Codes
E2373 (NU) E2374 (NU) E2375 (NU) E2376 (NU) E2377 (NU) E2381 (NU) E2382 (NU) E2383 (NU) E2384 (NU) E2385 (NU) E2386 (NU) E2387 (NU) E2388 (NU) E2389 (NU) E2390 (NU) E2391 (NU) E2392 (NU) E2393 (NU) E2394 (NU) E2395 (NU) E2396 (NU) K0733 (NU) K0734 (NU) K0735 (NU) K0736 (NU) K0737 (NU) K0800 (NU) K0800 (RR) K0801 (NU) K0801 (RR) K0802 (NU) K0802 (RR) K0806 (NU) K0806 (RR) K0807 (NU) K0807 (RR) K0808 (NU) K0808 (RR) K0813 (NU) K0813 (RR) K0814 (NU) K0814 (RR) K0815 (NU) K0815 (RR) K0816 (NU) K0816 (RR) K0820 (NU) K0820 (RR) K0821 (NU) K0821 (RR) K0822 (NU) K0822 (RR) K0823 (NU) K0823 (RR) K0824 (NU) K0824 (RR) K0825 (NU) K0825 (RR) K0826 (NU) K0826 (RR) K0827 (NU) K0827 (RR) K0828 (NU) K0828 (RR) K0829 (NU) K0829 (RR) K0830 (NU) K0830 (RR) K0831 (NU) K0831 (RR) K0835 (NU) K0835 (RR) K0836 (NU) K0836 (RR) K0837 (NU) K0837 (RR) K0838 (NU) K0838 (RR) K0839 (NU) K0839 (RR) K0840 (NU) K0840 (RR) K0841 (NU) K0841 (RR) K0842 (NU) K0842 (RR) K0843 (NU) K0843 (RR) K0848 (NU) K0848 (RR) K0849 (NU) K0849 (RR) K0850 (NU) K0850 (RR) K0851 (NU) K0851 (RR) K0852 (NU) K0852 (RR) K0853 (NU) K0853 (RR) K0854 (NU) K0854 (RR) K0855 (NU) K0855 (RR) K0856 (NU) K0856 (RR) K0857 (NU) K0857 (RR) K0858 (NU) K0858 (RR) K0859 (NU) K0859 (RR) K0860 (NU) K0860 (RR) K0861 (NU) K0861 (RR) K0862 (NU) K0862 (RR) K0863 (NU) K0863 (RR) K0864 (NU) K0864 (RR) The power mobility device HCPCS procedure codes being end-dated from the MA Program Outpatient Fee Schedule, which will no longer be compensable under the MA Program for services provided after September 23, 2007, are as follows:
Procedure Codes
E0997 E0998 E0999 E2320 K0090 K0091 K0092 K0093 K0094 K0095 K0096 K0097 K0099 Prior Authorization Requirements
The following new 2007 power mobility device HCPCS procedure codes are for purchases of appliances or equipment that cost more than $600 and therefore require prior authorization under section 443.6(b)(2) of the Public Welfare Code (code) (62 P. S. § 443.6(b)(2)), as amended by the act of July 7, 2005 (P. L. 177, No. 42):
Procedure
Procedure Description Pricing Code Modifier E2373 Power wheelchair accessory, hand or chin control interface, miniproportional, compact, or short throw remote joystick or touchpad, proportional, including all related electronics and fixed mounting hardware NU E2375 Power wheelchair accessory, nonexpandable controller, including all related electronics and mounting hardware, replacement only NU E2376 Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only NU K0800 Power operated vehicle, group 1 standard duty, patient weight capacity up to including 300 pounds NU K0801 Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds NU K0802 Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds NU K0806 Power operated vehicle, group 2 standard duty, patient weight capacity up to and including 300 pounds NU K0807 Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds NU K0808 Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds NU K0813 Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds NU K0814 Power wheelchair, group 1 standard, portable, captain's chair, patient weight capacity up to and including 300 pounds NU K0815 Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds NU K0816 Power wheelchair, group 1 standard, captain's chair, patient weight capacity up to and including 300 pounds NU K0820 Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds NU K0821 Power wheelchair, group 2 standard, portable, captain's chair, patient weight capacity up to and including 300 pounds NU K0822 Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds NU K0823 Power wheelchair, group 2 standard, captain's chair, patient weight capacity up to and including 300 pounds NU K0824 Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds NU K0825 Power wheelchair, group 2 heavy duty, captain's chair, patient weight capacity 301 to 450 pounds NU K0826 Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds NU K0827 Power wheelchair, group 2 very heavy duty, captain's chair, patient weight capacity 451 to 600 pounds NU K0828 Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more NU K0829 Power wheelchair, group 2 extra heavy duty, captain's chair, patient weight capacity 601 pounds or more NU K0830 Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds NU K0831 Power wheelchair, group 2 standard, seat elevator, captain's chair, patient weight capacity up to and including 300 pounds NU K0835 Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds NU K0836 Power wheelchair, group 2 standard, single power option, captain's chair, patient weight capacity up to and including 300 pounds NU K0837 Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds NU K0838 Power wheelchair, group 2 heavy duty, single power option, captain's chair, patient weight capacity 301 to 450 pounds NU K0839 Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds NU K0840 Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more NU K0841 Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds NU K0842 Power wheelchair, group 2 standard, multiple power option, captain's chair, patient weight capacity up to and including 300 pounds NU K0843 Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds NU K0848 Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds NU K0849 Power wheelchair, group 3 standard, captain's chair, patient weight capacity up to and including 300 pounds NU K0850 Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds NU K0851 Power wheelchair, group 3 heavy duty, captain's chair, patient weight capacity 301 to 450 pounds NU K0852 Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds NU K0853 Power wheelchair, group 3 very heavy duty, captain's chair, patient weight capacity, 451 to 600 pounds NU K0854 Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more NU K0855 Power wheelchair, group 3 extra heavy duty, captain's chair, patient weight 601 pounds or more NU K0856 Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds NU K0857 Power wheelchair, group 3 standard, single power option, captain's chair, patient weight capacity up to and including 300 pounds NU K0858 Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds NU K0859 Power wheelchair, group 3 heavy duty, single power option, captain's chair, patient weight capacity 301 to 450 pounds NU K0860 Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds NU K0861 Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds NU K0862 Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds NU K0863 Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds NU K0864 Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more NU The following new 2007 power mobility device HCPCS procedure codes will require prior authorization after 3 months of rental as provided for in section 443.6(b)(3) of the code, as amended by the act of July 7, 2005 (P. L. 177, No. 42):
Procedure
Procedure Description Pricing Code Modifier K0800 Power operated vehicle, group 1 standard duty, patient weight capacity up to including 300 lbs RR K0801 Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds RR K0802 Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds RR K0806 Power operated vehicle, group 2 standard duty, patient weight capacity up to and including 300 pounds RR K0807 Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds RR K0808 Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds RR K0813 Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds RR K0814 Power wheelchair, group 1 standard, portable, captain's chair, patient weight capacity up to and including 300 pounds RR K0815 Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds RR K0816 Power wheelchair, group 1 standard, captain's chair, patient weight capacity up to and including 300 pounds RR K0820 Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds RR K0821 Power wheelchair, group 2 standard, portable, captain's chair, patient weight capacity up to and including 300 pounds RR K0822 Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds RR K0823 Power wheelchair, group 2 standard, captain's chair, patient weight capacity up to and including 300 pounds RR K0824 Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds RR K0825 Power wheelchair, group 2 heavy duty, captain's chair, patient weight capacity 301 to 450 pounds RR K0826 Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds RR K0827 Power wheelchair, group 2 very heavy duty, captain's chair, patient weight capacity 451 to 600 pounds RR K0828 Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more RR K0829 Power wheelchair, group 2 extra heavy duty, captain's chair, patient weight capacity 601 pounds or more RR K0830 Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds RR K0831 Power wheelchair, group 2 standard, seat elevator, captain's chair, patient weight capacity up to and including 300 pounds RR K0835 Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds RR K0836 Power wheelchair, group 2 standard, single power option, captain's chair, patient weight capacity up to and including 300 pounds RR K0837 Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds RR K0838 Power wheelchair, group 2 heavy duty, single power option, captain's chair, patient weight capacity 301 to 450 pounds RR K0839 Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds RR K0840 Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more RR K0841 Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds RR K0842 Power wheelchair, group 2 standard, multiple power option, captain's chair, patient weight capacity up to and including 300 pounds RR K0843 Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds RR K0848 Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds RR K0849 Power wheelchair, group 3 standard, captain's chair, patient weight capacity up to and including 300 pounds RR K0850 Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds RR K0851 Power wheelchair, group 3 heavy duty, captain's chair, patient weight capacity 301 to 450 pounds RR K0852 Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds RR K0853 Power wheelchair, group 3 very heavy duty, captain's chair, patient weight capacity, 451 to 600 pounds RR K0854 Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more RR K0855 Power wheelchair, group 3 extra heavy duty, captain's chair, patient weight 601 pounds or more RR K0856 Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds RR K0857 Power wheelchair, group 3 standard, single power option, captain's chair, patient weight capacity up to and including 300 pounds RR K0858 Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds RR K0859 Power wheelchair, group 3 heavy duty, single power option, captain's chair, patient weight capacity 301 to 450 pounds RR K0860 Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds RR K0861 Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds RR K0862 Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds RR K0863 Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds RR K0864 Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more RR Fiscal Impact
It is anticipated that these revisions will result in costs of $0.138 million ($0.064 million in State funds) in the MA Outpatient Program in Fiscal Year 2007-2008 and annualized costs of $0.237 million ($0.109 million in State funds) in Fiscal Year 2008-2009.
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, Attention: Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received 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 AT&T Relay Service (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-520. (1) General Fund:
MA-Outpatient (2) Implementing Year 2007-08 is $64,000 (3) 1st succeeding Year 2008-09 is $109,000 2nd succeeding Year 2009-10 is $109,000 3rd succeeding Year 2010-11 is $109,000 4th succeeding Year 2011-12 is $109,000 5th succeeding Year 2012-13 is $109,000 (4) 2006-07 Program-- $671,472,000 2005-06 Program-- $945,950,000 2004-05 Program-- $842,991,000 (7) Medical Assistance Outpatient; (8) recommends adoption. Funds have been included in the budget to cover these increases.
[Pa.B. Doc. No. 07-1723. Filed for public inspection September 14, 2007, 9:00 a.m.]
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