Keystone State Releases New Medical Fee Schedule

Tuesday, July 3, 2018 | 0

The Pennsylvania Department of Labor & Industry has released its 2018 medical fee schedule, which includes an increase corresponding to a 3% rise in the average weekly wage in the state, the department announced this week.

The schedule covers Part A medical providers, such as skilled nursing facilities, home health agencies, ambulatory surgical centers, pharmacies and physical therapy providers, as well as other providers covered under Part B, according to a bulletin.

Since 1995, medical fees for outpatient services are capped at 113% of the Medicare reimbursement rate and are updated annually by the percentage change in the statewide weekly average, a memo explains.

"If a Medicare allowance does not exist for a reported HCPCS (health care common procedure coding system) code, or successor codes, the provider shall be paid either 80% of the usual and customary charge, or the actual charge, whichever is lower," the memo said.

Questions or comments about the fees may be sent to RA-LI-BWC-HCSRD@pa.gov.