Summary
Already effective July 13, 2009: 2008 HCPCS procedure codes and codes added through program exception requests are added to the Pennsylvania MA fee schedule, and codes already on the schedule are updated. The updates add POS 24 and SG modifier entries, end-date 80 modifier fees, end-date TC and total component fees, add 26 modifier fees for physician services, limit some codes to the inpatient setting (POS 21), and end-date RR modifier component fees.
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What to do
Action · 3 steps
01Already effective July 13, 2009: Billing team should check each code in charge entry against the provider type, provider specialty, place of service, pricing and informational modifiers, and limits listed in the fee schedule before billing.
02Codes marked Prior Authorization Required Yes need prior authorization before billing: A9155, E0482 for purchase, E0856 (PA required for RR with the 1st month rental), E2312, E2313, E2397, J1642, L3925, L3927, L3929, L3931, L7611, L7612, L7613, L7614, L7621, L7622, and 75557, 75559, 75561, 75563 (see MAB 99-08-08).
03Use modifier 50 on bilateral codes where the chart lists it, with RT and LT modifiers, and observe the listed limits such as once per day, 1 per 90 days, 1 per 1095 days, or once per lifetime.
Codes mentioned
019350193620555210732220622207222082435724358243592726727268272692741627726277672776827769298282990429905299062990732421324223255032551325603325733258332593386435523365934101949203492044920549440494414944249446494504945149452494604946550385503865110051101511025264955920572855742358570585715857258573603006704167042670436711367229688167555775559755617556380047826108399384704863568750087809906819069695981959829612599477A5083A7027A7028A7029A9155B4087B4088E0856E2312E2313E2397J7347J7349L3925L3927L3929L3931L7611L7612L7613L7614L7621L7622S2066S2067S9152787098005080416804179087597532A6412B4224E0482J1642S36451582121127243463652242890443765855565880936422128058563595157353074327743287432974330743407589375898759617474093510211882119394760E2311E2321E2322E2325E2327E2328E2329E2330
Original notice
d 005501
pa.gov · Always check the source before changing claims.
Related changes
See all Pennsylvania Medicaid (DHS) changes →MAB2022082602MediumEffective Aug 29, 2022 · Provider BulletinMAB2024012401MediumNo effective date · Provider BulletinMAB2024021301HighEffective Mar 1, 2024 · Provider BulletinMAB2024042901MediumEffective Apr 29, 2024 · Provider BulletinBrowse every Pennsylvania Medicaid (DHS) change in the policy list
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