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PA Bulletin, Doc. No. 24-949

NOTICES

DEPARTMENT OF HUMAN SERVICES

Medical Assistance Program Fee Schedule Updates for Ophthalmology Services

[54 Pa.B. 3850]
[Saturday, July 6, 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 August 1, 2024.

Discussion

 The Department is increasing the fees for certain ophthalmology services as follows:

Procedure
Code 		National Code Description ModifierCurrent
MA Fee 		New MA
Fee
92004Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits$58.77$89.90
92012Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient$29.41$47.90
92014Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient,
1 or more visits		$45.28$72.26
92015Determination of refractive state$4.50$17.60
92235Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral$45.50$152.10
92235Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateralTC$27.30$112.01
92235Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral26$18.20$40.90

Fiscal Impact

 There is minimal fiscal impact associated with the updates of these procedure codes.

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-1639. No fiscal impact; recommends adoption.

[Pa.B. Doc. No. 24-949. Filed for public inspection July 5, 2024, 9:00 a.m.]


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