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PA Bulletin, Doc. No. 09-1904


Medical Assistance Program Fee Schedule: Addition of Procedure Code for the Administration of H1N1 Vaccines

[39 Pa.B. 5995]
[Saturday, October 10, 2009]

Purpose of Notice

 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 90470 for the administration of H1N1 vaccines, effective October 5, 2009.

Procedure Code Description MA Fee
90470 H1N1 immunization administration (intramuscular, intranasal), including counseling when performed $10

 This procedure code is being added to the Medical Assistance (MA) Program Fee Schedule as a result of the recent United States Food and Drug Administration approval of the use of H1N1 influenza vaccines that protect against the H1N1 virus. The Department will issue an MA Bulletin to providers with specific instructions concerning billing for the administration of the H1N1 influenza vaccines.

 The Centers for Disease Control and Prevention is distributing the H1N1 vaccines to each State at no cost for both private and public patients across all target groups. Providers may contact the Department of Health or the Philadelphia Department of Public Health to order and obtain the H1N1 vaccine.

Fiscal Impact

 It is estimated that this change will result in costs of $5.566 million ($1.901 million in State funds) in the Medical Assistance (MA) Outpatient Program in Fiscal Year (FY) 2009-2010 and $5.566 million ($2.218 million in State funds) in FY 2010-2011. These State fund estimates are based on the increased Federal Assistance Percentages as determined under the American Recovery and Reinvestment Act (ARRA) of 2009.

Public Comments

 Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days 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 should submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


Fiscal Note: 14-NOT-625. (1) General Fund; (2) Implementing Year 2009-10 is $1.901M; (3) 1st Succeeding Year 2010-11 is $2.218M; 2nd Succeeding Year 2011-12 is $2.535M; 3rd Succeeding Year 2012-13 is $2.535M; 4th Succeeding Year 2013-14 is $2.535M; 5th Succeeding Year 2014-15 is $2.535M; (4) 2008-09 Program—$519.681M; 2007-08 Program—$593.992M; 2006-07 Program—$671.472M; (7) MA—Outpatient; (8) recommends adoption.

 The Centers for Disease Control and Prevention will distribute H1N1 vaccines to each state at no cost for both the private and public patients across all target groups. Costs to administer the additional vaccines will be covered at part of MA—Outpatient appropriation.

[Pa.B. Doc. No. 09-1904. Filed for public inspection October 9, 2009, 9:00 a.m.]

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