Please contact Betty Simmonds at PCPA with questions about this Alert.
On March 10 the Office of Medical Assistance Programs posted a PROMISe™ Remittance Advice Notice to the Department of Public Welfare web site under "What’s New," (www.dpw.state.pa.us/omap/provinf/RA022105a.asp).
Effective March 1 PROMISe™ changes were implemented to correct the application of co-payments for several behavioral health services. Behavioral health services under fee-for-service have co-payment requirements, with the exception of partial hospitalization, services to children under age 18, and services to pregnant women. Certain psychotherapy services have a $.50 co-payment for each one half hour unit of service provided for all categories of recipients; except General Assistance recipients, which require a $1.00 co-payment for each half hour of psychotherapy service provided. These services include: individual psychotherapy, group psychotherapy, family psychotherapy and collateral family psychotherapy. Procedure codes are:
- W9801- individual psychotherapy;
- W0981 – group psychotherapy;
- W0983 – family psychotherapy;
- W0984 – collateral family psychotherapy;
- W0148 – psychotherapy, individual, family or collateral in quarter hour increments after initial half hour; and
- W0149 – psychotherapy, individual or family in quarter hour increments after the initial half hour session.
For other behavioral health services, the sliding fee co-payment scale based upon the Medical Assistance fee for the service provided is used.
| MA Fee for the Service | Co-Payment |
| $0.01 - $1.99 | $0.00 |
| $2.00 - $10.00 | $0.50 |
| $10.01 - $25.00 | $1.00 |
| $25.01 - $50.00 | $2.00 |
| $50.01 or more | $3.00 |
For General Assistance recipients, the sliding fee co-payment is based upon the following:
| MA Fee for the Service | Co-Payment |
| $0.01 - $1.99 | $0.00 |
| $2.00 - $10.00 | $1.050 |
| $10.01 - $25.00 | $2.00 |
| $25.01 - $50.00 | $4.00 |
| $50.01 or more | $6.00 |
Please contact Betty Simmonds at PCPA with questions about this Alert.