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PA Bulletin, Doc. No. 23-1612

NOTICES

DEPARTMENT OF HUMAN SERVICES

Medical Assistance Program Fee Schedule; Addition of a Procedure Code for Sexually Transmitted Infection Test Kits

[53 Pa.B. 7255]
[Saturday, November 18, 2023]

 In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Human Services (Department) announces it will add sexually transmitted infection (STI) test kits for at-home specimen collection to the Medical Assistance (MA) Program Fee Schedule, effective with dates of services on and after December 1, 2023.

Background

 The MA Program currently covers STI testing, sometimes referred to as sexually transmitted disease testing, for MA beneficiaries in the in-person setting, including at a laboratory, clinic or provider's office. The Department received requests to cover at-home testing to increase access to STI testing. The Department is expanding testing options and will cover at-home test kits purchased at the pharmacy or mailed, when prescribed by an enrolled provider.

New Procedure Code and Modifiers

 The Department is adding procedure code A9999 with U3 (pricing), U4 (pricing) and U5 (pricing) modifiers for provider type 24 (Pharmacy), for the coverage of at-home specimen collection STI test kits that are picked up at the pharmacy by MA beneficiaries and returned by the MA beneficiary through the mail to the laboratory for processing.

 The Department is adding procedure code A9999 with U6 (pricing), U7 (pricing) and U8 (pricing) modifiers for provider type 28 (Laboratory), for the coverage of at-home specimen collection STI test kits that are mailed by the laboratory to MA beneficiaries and returned by the MA beneficiary through the mail to the laboratory for processing.

Procedure
Code		National Code DescriptionModifierMA Fee
A9999Miscellaneous DME supply or accessory, not otherwise specifiedU3
(To be used for STI Test Kit, up to 3 panels, includes return shipping to laboratory)		$66    
A9999Miscellaneous DME supply or accessory, not otherwise specifiedU4
(To be used for STI Test Kit, up to 5 panels, includes return shipping to laboratory)		$164.75
A9999Miscellaneous DME supply or accessory, not otherwise specifiedU5
(To be used for STI Test Kit, 6 or more panels, includes return shipping to laboratory)		$169   
A9999Miscellaneous DME supply or accessory, not otherwise specifiedU6
(To be used for STI Test Kit, up to 3 panels, includes shipping both to the home of the beneficiary and return to laboratory)		 $86    
A9999Miscellaneous DME supply or accessory, not otherwise specifiedU7
(To be used for STI Test Kit, up to 5 panels, includes shipping both to the home of the beneficiary and return to laboratory)		$184.75
A9999Miscellaneous DME supply or accessory, not otherwise specifiedU8
(To be used for STI Test Kit, 6 or more panels, includes shipping both to the home of the beneficiary and return to laboratory)		$189   

 The Department will issue an MA Bulletin to providers enrolled in the MA Program advising of the addition of this new procedure code and modifiers to the MA Program Fee Schedule for coverage of at-home specimen collection STI testing kits.

Fiscal Impact

 The estimated annualized cost beginning in Fiscal Year 2023-2024 is $0.00 million in total funds.

Public Comment

 Interested persons are invited to submit written comments regarding the addition of the procedure codes for STI test kits to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120 or to RA-PWMAProgComments@pa.gov. Comments received within 30 days will be reviewed and considered for any subsequent revision 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, 
Secretary

 Fiscal Note: 14-NOT-1598. No fiscal impact; recommends adoption.

[Pa.B. Doc. No. 23-1612. Filed for public inspection November 17, 2023, 9:00 a.m.]


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