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PA Bulletin, Doc. No. 22-1483



Medical Assistance Program Fee Schedule Addition

[52 Pa.B. 6117]
[Saturday, September 24, 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 dental services, effective with dates of service on and after May 2, 2022.

Procedure Code Code Description Fee  Limit Places of Service
D1310 Nutritional counseling for control of dental disease $10.87 1 per 180 days in combination with D1330, totaling 12 minutes or more 02, 11, 12, 31, 32, 99
D1330 Oral hygiene instructions $11.08 1 per 180 days in combination with D1310, totaling 12 minutes or more 02, 11, 12, 31, 32, 99


 The Department updated the MA Program Fee Schedule to include Healthcare Common Procedure Coding System codes D1310 and D1330, effective with dates of service on and after May 2, 2022. These codes, which can be rendered by means of teledentistry or in-person, must be billed together.

 The Department issued an MA Bulletin to inform providers enrolled in the MA Program of the addition of the procedure codes previously noted and billing instructions for the use of these codes.

Fiscal Impact

 The estimated cost for Fiscal Year 2022-2023 is $0.148 million.

Public Comment

 Interested persons are invited to submit written comments to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120 or at Comments received within 30 days will be reviewed and considered for any subsequent revision of the notice.

 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-1530. (1) General Fund; (2) Implementing Year 2022-23 is $71,000; (3) 1st Succeeding Year 2023-24 through 5th Succeeding Year 2027-28 are $71,000; (4) 2021-22 Program—$644,059,000; 2020-21 Program—$808,350,000; 2019-20 Program—$344,107,000; (7) MA—Fee-for-Service; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 22-1483. Filed for public inspection September 23, 2022, 9:00 a.m.]

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