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PA Bulletin, Doc. No. 22-1484



Medical Assistance Program Fee Schedule Additions

[52 Pa.B. 6118]
[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 the provision of private duty nursing services which are provided through Home Health Agencies (HHA) and rendered to MA beneficiaries under 21 years of age, effective with dates of service on and after October 1, 2022.

Procedure Code Code Description Fee Unit Limit Age Limit Prior Authorization Required
T1002 RN services, up to 15 minutes $12.50
per unit
96 per day Age 0—20 Yes
T1003 LPN services, up to 15 minutes $12.50
per unit
96 per day Age 0—20 Yes


 The MA Program pays HHAs to provide private duty nursing services to beneficiaries under 21 years of age. These services are provided to MA beneficiaries in the beneficiary's home and in community settings, prescribed as part of a written plan of treatment and provided by a registered nurse or licensed practical nurse.

 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 T1002 and T1003 will require prior authorization, as authorized by section 443.6(b)(7) of the Human Services Code (62 P.S. § 443.6(b)(7)), regarding reimbursement of certain MA items and services.

Fiscal Impact

 The Department does not anticipate any fiscal impact related to the addition of procedure codes T1002 and T1003 to the MA Program Fee Schedule, as private duty nursing services are already covered in the MA Program for beneficiaries under 21 years of age.

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

Acting Secretary

Fiscal Note: 14-NOT-1531. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 22-1484. Filed for public inspection September 23, 2022, 9:00 a.m.]

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