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PA Bulletin, Doc. No. 22-575



Medical Assistance Program Fee Schedule Additions

[52 Pa.B. 2297]
[Saturday, April 16, 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 the following procedure codes to the Medical Assistance (MA) Program Fee Schedule for the provision of personal care services (PCS), which are provided through Home Health Agencies (HHAs) rendered to MA beneficiaries under 21 years of age, effective with dates of service on and after May 1, 2022.

Procedure Code Code Description Fee Unit Limit Age Limit
T1019 Personal Care Services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment $6.84 per unit 96 per day Age 0—20
S9122 Home health aide or certified nurse assistant, providing care in the home; per hour $27.36 per unit 24 per day Age 0—20


 The MA Program pays HHAs to provide PCS to beneficiaries under 21 years of age. These services are provided in the beneficiary's home and community settings, in accordance with a plan of treatment and provided by a home health aide under the supervision of a registered nurse. PCS consist of services that support activities of daily living such as ambulation, bathing, toileting, beneficiary transfers (for example, transfer from bed to chair/chair to bed) and personal hygiene.

 Although the Department has used procedure code S9122 for home health aide services, the procedure code is not on the MA Program Fee Schedule and has been available only through the program exception process. It is now being added to the MA Program Fee Schedule. In addition, the Department is adding procedure code T1019 to allow providers to seek authorization of, and bill for, PCS for MA beneficiaries under 21 years of age in 15-minute increments.

 These procedure codes are available for Provider Type/Specialty combination 05/050 (Home Health/Home Health Services) in Place of Service 12 (Home) with no modifiers.

Prior Authorization Requirements

 Procedure codes T1019 and S9122 will require prior authorization, as authorized by section 443.6(b)(7) (62 P.S. § 443.6(b)(7)) regarding reimbursement of certain medical assistance items and services, of the act of June 13, 1967, (P.L. 31, No. 21), known as the Human Services Code.

Fiscal Impact

 The Department does not anticipate any fiscal impact related to the addition of procedure codes T1019 and S9122 to the MA Program Fee Schedule, as PCS are already rendered to MA beneficiaries under 21 years of age.

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 (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

Acting Secretary

Fiscal Note: 14-NOT-1504. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 22-575. Filed for public inspection April 15, 2022, 9:00 a.m.]

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