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PA Bulletin, Doc. No. 18-303

NOTICES

DEPARTMENT OF HUMAN SERVICES

Clinical Laboratory Improvement Amendments Excluded Laboratory Services Update; Medical Assistance Fee Schedule Revisions

[48 Pa.B. 1239]
[Saturday, February 24, 2018]

 The Department of Human Services (Department) announces changes to the Medical Assistance (MA) Program Fee Schedule. These changes are effective for dates of service on and after February 26, 2018.

 Each year, the Centers for Medicare & Medicaid Services provides an updated list of Current Procedural Terminology (CPT) codes that are laboratory tests under section 353 of the Clinical Laboratory Improvement Amendments of 1988 (CLIA) (42 U.S.C.A. § 263a), that are excluded from CLIA certificate requirements under the CLIA regulations, 42 CFR Part 493 (relating to laboratory requirements). The Department identified seven procedure codes in this list to add to the MA Fee Schedule, and six codes that need to be opened to additional provider types, provider specialties and places of service, to make these services available outside a laboratory setting.

 Therefore, the Department is adding certain outpatient laboratory CPT procedure codes to the MA Program Fee Schedule that are excluded from CLIA certificate requirements. In addition, the Department is adding certain Provider Types (PT), Provider Specialties (Spec) and Places of Service (POS) to certain outpatient laboratory CPT procedure codes that are excluded from CLIA certificate requirements and already open on the MA Program Fee Schedule.

 The Department will issue an MA Bulletin to inform providers of the updates.

Additions to the MA Fee Schedule

 The Department is adding the following procedure codes with the associated PT, Spec and POS combinations to the MA Program Fee Schedule:

Procedure Code Description Provider Type Provider Specialty Place of Service MA Fee Prior Auth. Units Limits
83013 Helicobacter pylori; breath test analysis for urease activity, nonradioactive isotope (for example, c-13) 01 016 23 $60.10 No Per test Once per day
01 017 23
01 183 22
08 082 49
09 All 11
28 280 81
31 All 11
86077 Blood bank physician services; difficult cross match and/or evaluation of irregular antibody(s), interpretation and written report 01 017 23 $41.83 No Per procedure Once per day
01 183 22
08 082 49
28 280 81
31 All 11, 21, 23
86078 Blood bank physician services; investigation of transfusion reaction including suspicion of transmissible disease, interpretation and written report 01 017 23 $41.56 No Per procedure Once per day
01 183 22
08 082 49
28 280 81
31 All 11, 21, 23
86079 Blood bank physician services; authorization for deviation from standard blood banking procedures (for example, use of outdated blood, transfusion of Rh incompatible units), with written report 01 017 23 $41.56 No Per procedure Once per day
01 183 22
08 082 49
28 280 81
31 All 11, 21, 23
88329 Pathology consultation during surgery 01 016 23 $29.77 No Per procedure Once per day
01 017 23
01 183 22
08 082 49
27 All 11, 21, 24
28 280 81
31 All 11, 21, 24
88738 Hemoglobin (Hgb), quantitative, transcutaneous 01 016 23 $4.47 No Per test Once per day
01 017 23
01 183 22
08 082 49
09 All 11
28 280 81
31 All 11
33 335 11
89049 Caffeine halothane contracture test for malignant hyperthermia susceptibility, including interpretation and report 01 183 22 $53.03 No Per test Once per day
28 280 81

Updates to Procedure Codes Currently on the MA Program Fee Schedule

 The Department is adding the following PT, Spec and POS combinations to the procedure codes:

Procedure Code Description Provider Type Provider Specialty Place of Service
86485 Skin test; candida 08 082 49
09 All 11
31 All 11
33 335 11
86490 Skin test; coccidioidomycosis 08 082 49
09 All 11
31 All 11
33 335 11
86510 Skin test: histoplasmosis 08 082 49
09 All 11
31 All 11
33 335 11
87900 Infectious agent drug susceptibility phenotype prediction using regularly updated genotype bioinformatics 31 All 11
88720 Bilirubin, total transcutaneous 08 082 49
09 All 11, 12
31 All 11, 12
33 335 11, 12
88740 Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin 08 082 49
09 All 11
31 All 11

Fiscal Impact

 The estimated cost for Fiscal Year 2017-2018 is $0.038 million ($0.018 million in State funds).

Public Comment

 Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, 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 Pennsylvania AT&T Relay Service (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

TERESA D. MILLER, 
Acting Secretary

Fiscal Note: 14-NOT-1210. (1) General Fund; (2) Implementing Year 2017-18 is $18,000; (3) 1st Succeeding Year 2018-19 through 5th Succeeding Year 2022-23 are $74,000; (4) 2016-17 Program—$450,970,000; 2015-16 Program—$392,918,000; 2014-15 Program—$564,772,000; (7) MA—Fee-for-Service; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 18-303. Filed for public inspection February 23, 2018, 9:00 a.m.]



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