Summary
The Pennsylvania Department of Public Welfare, Office of Medical Assistance Programs, lists 2007 HCPCS codes and other procedure codes, and procedure code and modifier combinations, effective March 15, 2008. Each row gives the provider type, specialty, place of service, pricing and informational modifiers, the MA fee, whether prior authorization is required, and limits. Prior authorization is marked Yes for codes including L1001 ($800.00, 1 per 365 days), L3806, L3808, L3915, the L6611 to L7009 prosthesis additions and terminal devices (1 per extremity per 1095 days for most), L8691 (1 per 5 calendar years), C1300 hyperbaric oxygen, 15830, 15847, 19300, gastric restrictive procedures 43644 and 43770 to 43774, hearing device codes 69710 to 69718, PET code 78608, and BRCA codes S3818 to S3823 (1 per lifetime). For K0738 the prior authorization note says it is required for the first 45 days unless the physician certifies the recipient and home are adequately prepared, and for E0619 it says prior authorization is required from the initial date of service. Other rows are marked No prior authorization, for example A4461 at $2.63 (10 per 30 days) and A8000 at $122.68 (2 per 365 days).
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