RCPA - Rehabilitation and Community Providers Association


OMAP Moves to National Procedure Codes
September 8, 2005

On September 8 the Office of Medical Assistance Programs (OMAP) released a new bulletin – Medical Assistance Program Fee Schedule Procedure Code Changes for Behavioral Health Services. The bulletin announces OMAP’s intent to eliminate 82 local procedure codes used in Pennsylvania’s Medical Assistance program as required by the administrative simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA). The Department of Public Welfare is adopting national procedure codes and modifiers for behavioral health services that are to be used in place of local procedure codes with dates of service on or after October 1. The change affects those providers who render behavioral health services to recipients in the fee-for-service system

As noted in the bulletin:
Several of the national procedure codes to which the local procedure codes were cross walked have a different unit of service associated with them than the unit of service associated with the local procedure code being replaced. As a result of this change in the unit of service, there has been a change in the per unit rate for the procedure code. However, the payment rate and policies for the service have not changed. For example, if the local procedure code has a one hour unit of service and the national procedure code to which the local procedure code was cross walked has a 15 minute unit of service, providers using the national procedure code to bill for an hour of service would bill for four units of service, whereas providers using the local procedure code would bill for one unit of service. Regardless of whether the provider used the national procedure code or the local procedure code, the provider would receive the same payment.

The bulletin is accessible from the DPW web site at www.dpw.state.pa.us/omap/provinf/mabull/080505.asp. A crosswalk between local and national codes is attached to the bulletin.

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