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PA Bulletin, Doc. No. 03-717


Medical Assistance Program Fee Schedule; Addition of Procedure Code

[33 Pa.B. 2020]

   In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Public Welfare (Department) announces the addition of Procedure Code 90723, for the administration of Pediarix vaccine, to the Medical Assistance Program Fee Schedule effective January 1, 2003.

   Recently approved by the United States Food and Drug Administration, Pediarix is a combination vaccine that protects infants against diphtheria, tetanus, pertussis (whooping cough), polio and Hepatitis B virus. It is administered as one intramuscular injection. Providers should bill the Department for the administration of the Pediarix vaccine using Procedure Code 90723.

Code Description Fee
90723 Immunization, diphtheria, tetanus
toxoids, acellular pertussis vaccine,
Hepatitis B and poliovirus vaccine,
inactivated (DtaP-HepB-IPV), for
intramuscular use

Fiscal Impact

   The fiscal note was prepared under the authority of section 612 of The Administrative Code of 1929 (71 P. S. § 232).


   Interested persons are invited to submit written comments regarding this notice to the Department within 30 days of publication of this notice in the Pennsylvania Bulletin. Comments received will be reviewed and considered in subsequent revisions to the Medical Assistance Program Fee Schedule. Comments should be addressed to Department of Public Welfare, Office of Medical Assistance Programs, Attention: Suzanne Love, P. O. Box 2675, Harrisburg, PA 17105.

   Persons with a disability may use the AT&T Relay Services by calling (800) 654-5984 (TTD users) or (800) 654-5988 (voice users).


   Fiscal Note:  14-NOT-354. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 03-717. Filed for public inspection April 18, 2003, 9:00 a.m.]

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