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PA Bulletin, Doc. No. 22-533

NOTICES

DEPARTMENT OF HUMAN SERVICES

Medical Assistance Program Fee Schedule Addition

[52 Pa.B. 2191]
[Saturday, April 9, 2022]

 In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Human Services (Department) announces the addition of two procedure codes to the Medical Assistance (MA) Program Fee Schedule for use in laboratory testing for multiple respiratory pathogens, including SARS-CoV-2 (COVID-19), effective with dates of service on and after March 21, 2022.

Fee Schedule Addition

 The Department is adding the following procedure codes to the MA Program Fee Schedule as follows:

Procedure
Code
Procedure Code
Description
Provider Type/ Specialty Place of Service/ Modifier MA Fee Limits Prior Authorization Required
87636 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19)) and influenza virus types A and B, multiplex amplified probe technique 01/016
01/016
01/017
01/017
01/183
01/183
08/082
08/082
09/All
09/All
10/100
10/100
28/280
28/280
31/All
31/All
33/335
33/335
23
23/QW
23
23/QW
22
22/QW
49
49/QW
11
11/QW
11
11/QW
81
81/QW
11
11/QW
11
11/QW
$112.86
per test
1 test
per day
No
87637 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19)), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique 01/016
01/016
01/017
01/017
01/183
01/183
08/082
08/082
09/All
09/All
10/100
10/100
28/280
28/280
31/All
31/All
33/335
33/335
23
23/QW
23
23/QW
22
22/QW
49
49/QW
11
11/QW
11
11/QW
81
81/QW
11
11/QW
11
11/QW
$112.86
per test
1 test
per day
No

Fiscal Impact

 There is no fiscal impact associated with this notice.

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 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 Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

MEG SNEAD, 
Acting Secretary

Fiscal Note: 14-NOT-1503. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 22-533. Filed for public inspection April 8, 2022, 9:00 a.m.]



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