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Tags Posts tagged with "MA Fee Schedule"

MA Fee Schedule

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The Pennsylvania Department of Human Services released Medical Assistance Bulletin 99-24-03 on May 28, 2024, detailing updates to the Medical Assistance (MA) Program Fee Schedule based on the 2024 Healthcare Common Procedure Coding System (HCPCS) changes. These updates include new codes such as 90867, 90868, and 90869 for transcranial magnetic stimulation (TMS) treatment billing, along with additional modifications to other procedure codes, setting of limitations, fee adjustments, and new prior authorization requirements effective from the same date. This bulletin applies to all providers serving MA beneficiaries under the Fee-for-Service system and those in the MA Managed Care system should contact their respective organizations for specific billing guidance.

For more detailed information, read the full bulletin here.

If you have any other questions, please contact RCPA COO and Policy Director Jim Sharp.

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The Department of Human Services (DHS) published a notice in the Pennsylvania Bulletin for November 12, 2022, that announces revisions to the Medical Assistance (MA) fee schedule for the OBRA Waiver and the Act 150 Program: Personal Assistance Services (PAS) (Agency with Choice) and Respite (Agency with Choice).

DHS proposes the following substantive and technical changes to the OBRA Waiver:

  • Add Agency with Choice as a Financial Management Services model for the participant-directed services of PAS and Respite;
  • Revise the Benefits Counseling service definition;
  • Amend the responsibilities of the Fiscal/Employer Agent;
  • Update the Quality Improvement Strategy to the current process;
  • Add a new performance measure for Agency with Choice; and
  • Remove a performance measure that is duplicative.

The proposed OBRA Waiver amendment and a summary of all revisions are available for review on the OLTL Waiver Amendments, Renewals, and Accompanying HCBS Transition Plans web page under Additional Resources.

The following table provides the procedure code and rates for PAS (Agency with Choice):

Region OBRA Waiver
and Act 150		 Procedure Code Modifier Rate Unit
1 X W0164 N/A $4.02 15 minutes
2 X W0164 N/A $3.89 15 minutes
3 X W0164 N/A $4.12 15 minutes
4 X W0164 N/A $4.58 15 minutes

The following table provides the procedure code and rates for Respite (Agency with Choice):

Region OBRA Waiver
and Act 150		 Procedure Code Modifier Rate Unit
1 X W0165 N/A $4 15 minutes
2 X W0165 N/A $3.90 15 minutes
3 X W0165 N/A $4.12 15 minutes
4 X W0165 N/A $4.59 15 minutes

Interested persons are invited to submit written comments regarding these fee schedule rates and the proposed amendment to the Department of Human Services, Office of Long-Term Living, Bureau of Policy Development and Communications Management, Attention: Robyn Kokus, P.O. Box 8025, Harrisburg, PA 17105-8025. Comments can also be sent via email. Use ”OBRA 2023” as the subject line. Comments received within 30 days will be considered in subsequent revisions to the fee schedule or for revisions to the proposed amendment.

The revisions to the fee schedule and the amendment are proposed to take effect April 1, 2023.

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