NOTICES
DEPARTMENT OF HUMAN SERVICES
Medical Assistance Program Fee Schedule Additions
[52 Pa.B. 6119]
[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 use when billing for diagnostic laboratory testing for the orthopoxvirus and for the administration of monkeypox vaccines, effective with dates of service on and after July 26, 2022.
Procedure Code Code Description Provider Type/ Specialty Place of Service MA Fee Prior Authorization Required Limits 87593 Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (for example, monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each 01/183 28/280 22
81$39.77 No one test per day 90611 Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, nonreplicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use 01/183 08/082 09/ALL 09/ALL 10/100 10/100 31/ALL 31/ALL 33/335 33/335 22
49
11
12
11
12
11
12
11
12$10 No once per day 90622 Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use 01/183 08/082 09/ALL 09/ALL 10/100 10/100 31/ALL 31/ALL 33/335 33/335 22
49
11
12
11
12
11
12
11
12$10 No once per day Background
On July 23, 2022, the World Health Organization declared monkeypox a public health emergency and the United States Department of Health and Human Services (HHS) issued a statement regarding the Biden-Harris Administration's actions to make vaccines, testing and treatments available and determination to accelerate the Biden-Harris Administration's response.
On July 26, 2022, the American Medical Association announced the addition of procedure code 87593 to report diagnostic laboratory testing for the orthopoxvirus, as well as procedure codes 90611 for the monkeypox and smallpox virus vaccine and 90622 for the vaccinia (smallpox) vaccine to the Current Procedural Terminology.
On August 4, 2022, HHS Secretary Xavier Becerra declared the ongoing spread of the monkeypox virus in the United States a Public Health Emergency to further strengthen and accelerate the Biden-Harris Administration's response to the continued rapid transmission of monkeypox.
The Department issued an MA Bulletin to enrolled providers to advise them of the addition to the MA Fee Schedule of the procedure codes for laboratory testing for the orthopoxvirus and the administration of the monkeypox vaccines.
Fiscal Impact
The estimated fiscal impact for Fiscal Year 2022-2023 is $0.178 million for Fee-for-Service. There is no fiscal impact for managed care.
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, P.O. Box 2675, Harrisburg, PA 17120 or to RA-PWMAProgComments@pa.gov. Comments received within 30 days will be reviewed and considered for any subsequent revisions of this 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).
MEG SNEAD,
Acting SecretaryFiscal Note: 14-NOT-1535. (1) General Fund; (2) Implementing Year 2022-23 is $85,000; (3) 1st Succeeding Year 2023-24 through 5th Succeeding Year 2027-28 are $0; (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. 22-1485. Filed for public inspection September 23, 2022, 9:00 a.m.]
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