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PA Bulletin, Doc. No. 19-52



Medical Assistance Program Fee Schedule Revisions; Clinical Laboratory Procedure Coding System Updates

[49 Pa.B. 263]
[Saturday, January 12, 2019]

 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 January 14, 2019.

 The Department is adding two clinical laboratory procedure codes related to Noninvasive Prenatal Screening to the MA Program Fee Schedule due to changes in American College of Obstetricians and Gynecologists (ACOG) guidelines. In ACOG Practice Bulletin No. 163, ACOG recommends that ''all women should be given the option of aneuploidy screening or diagnostic testing for fetal genetic disorders, regardless of maternal age.''

 Clinical laboratory procedure codes 81420 and 81507 being added to the MA Program Fee Schedule will require prior authorization, as authorized under section 443.6(b)(7) of the Human Services Code (62 P.S. § 443.6(b)(7)). The Department will issue a bulletin to advise MA providers of the updates to the MA Program Fee Schedule.

Procedure Codes Being Added

 The Department is adding clinical laboratory procedure codes 81420 and 81507 to the MA Program Fee Schedule as follows:

Procedure Code Description Provider Type Provider Specialty Place of Service MA Fee Prior Auth. Units Limits
81420 Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18 and 21 01 183 22 $607.24 yes per test once
per day
28 280 81
81507 Fetal aneuploidy (trisomy 21, 18 and 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy 01 183 22 $636.00 yes per test once
per day
28 280 81

Fiscal Impact

 The estimated fiscal impact in Fiscal Year 2018-2019 is $0.081 million ($0.039 million in State funds and $0.042 million in Federal funds). The estimated annualized fiscal impact is $0.324 million ($0.155 million in State funds and $0.169 in Federal 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).


Fiscal Note: 14-NOT-1305. (1) General Fund; (2) Implementing Year 2018-19 is $39,000; (3) 1st Succeeding Year 2019-20 through 5th Succeeding Year 2023-24 are $155,000; (4) 2017-18 Program—$477,690,000; 2016-17 Program—$450,970,000; 2015-16 Program—$392,918,000; (7) MA—Fee-for-Service; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 19-52. Filed for public inspection January 11, 2019, 9:00 a.m.]

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