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PA Bulletin, Doc. No. 22-1793



Medical Assistance Program Fee Schedule Addition

[52 Pa.B. 7217]
[Saturday, November 19, 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 procedure code K1034 to the Medical Assistance (MA) Program Fee Schedule for United States Food and Drug Administration (FDA)-authorized over-the-counter (OTC) SARS-CoV-2 (COVID-19) tests provided to MA Program beneficiaries, effective with dates of service on and after December 5, 2022. This notice also announces that the last date of service that providers can utilize procedure code T1999 for OTC COVID-19 tests is December 4, 2022.


 The Department published notice at 52 Pa.B. 1430 (March 5, 2022), that procedure code T1999 was to be used for OTC COVID-19 tests distributed to MA beneficiaries for dates of service on and after August 30, 2021.

Procedure Code Being Added

 The Department is adding the following procedure code, procedure code description and MA fee to the MA Program Fee Schedule, effective with dates of service on and after December 5, 2022:

Procedure CodeCode DescriptionMA Fee
K1034Provision of COVID-19 test, nonprescription self-administered and self-collected use, FDA approved, authorized or cleared, one test count$11.51

Procedure Code Being End-Dated

 Effective with dates of service on and after December 4, 2022, the MA Program is end-dating procedure code T1999 for OTC COVID-19 tests. The MA Program Fee Schedule has been updated to reflect this change.

Fiscal Impact

 There is no fiscal impact related to the addition of procedure code K1034 to the MA Program Fee Schedule, as the Department was already paying for OTC COVID-19 tests.

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 Comments received within 30 days will be reviewed and considered for any subsequent revision 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-1548. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 22-1793. Filed for public inspection November 18, 2022, 9:00 a.m.]

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