Last Updated: Dec 19, 2023

Department of Human Services

Addition of Interprofessional Consultation Services to the Medicaid State Plan and Medical Assistance Program Fee Schedule

On January 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued State Health Official Letter # 23-001 ''Coverage and Payment of Interprofessional Consultation in Medicaid and the Children's Health Insurance Program.'' In this letter, CMS issued guidance to allow for coverage and payment of interprofessional consultation services when the beneficiary is not present, and the consultation is for the direct benefit of the beneficiary. CMS' previous policy prohibited coverage and payment of provider-to-provider consultation as a distinct service.

In response to CMS' change in policy, the Department of Human Services (Department) announces the addition of interprofessional consultation service procedure codes 99446, 99447, 99448, 99449, 99451, and 99452 to the MA Program Fee Schedule, effective January 1, 2024.

The Department will issue an MA Bulletin to inform providers enrolled in the MA Program of the addition of the procedure codes for interprofessional consultation services.

Public Comment

Interested persons are invited to submit written comments to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120 or at RA-PWMAProgComments@ pa.gov. Comments received within 30 days will be reviewed and considered for any subsequent revisions to 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 (800) 654-5984 (TDD users) or (800) 654-5988 (voice users). 

For more information, please review the December 16, 2023 edition of the Pennsylvania Bulletin.