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PA Bulletin, Doc. No. 22-1061



Medical Assistance Program Fee Schedule Addition

[52 Pa.B. 4047]
[Saturday, July 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 code to the Medical Assistance (MA) Program Fee Schedule for disposable surgical masks, effective with dates of service on and after July 1, 2022.

Procedure Code Code Description Fee Unit Limit Age Limit
A4928Surgical Mask, per 20 $19.96 per box 2 boxes per month Age 2—120


 The Department updated the MA Program Fee Schedule to include Healthcare Common Procedural Coding System code A4928 for the distribution of disposable surgical masks to MA beneficiaries to help prevent the spread of disease.

 The Department issued an MA Bulletin to inform providers enrolled in the MA Program of the addition of the previously noted procedure code for the distribution of disposable surgical masks to MA beneficiaries to help prevent the spread of disease.

Fiscal Impact

 The estimated cost for Fiscal Year 2022-2023 is $0.943 million in the Fee-for-Service delivery system. There is no fiscal impact to Managed Care delivery system.

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 within 30 days will be reviewed and considered for any subsequent revisions of 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).

Acting Secretary

Fiscal Note: 14-NOT-1520. (1) General Fund; (2) Implementing Year 2021-22 is $0; (3) 1st Succeeding Year 2022-23 through 5th Succeeding Year 2026-27 are $420,000; (4) 2020-21 Program—$808,350,000; 2019-20 Program—$344,107,000; 2018-19 Program—$342,544,000; (7) MA—Fee-for-Service; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 22-1061. Filed for public inspection July 15, 2022, 9:00 a.m.]

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