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    Maryland Register

    Issue Date:  September 28, 2018

    Volume 45 • Issue 20 • Page 925-926


    Title 10 


    10.09.02 Physician Services

    Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

    Notice of Proposed Action


    The Secretary of Health proposes to amend Regulation .07 under COMAR 10.09.02 Physician Services.

    Statement of Purpose

    The purpose of this action is to update the Maryland Medical Assistance Program’s Professional Services Provider Manual and Physicians’ Services Fee Schedule, which is incorporated by reference, in order to reflect an increase in the Evaluation and Management procedure codes for physicians from 92 percent to 93 percent of the Medicare rate pursuant to the Governor’s FY 2019 budget.


    Comparison to Federal Standards

    There is no corresponding federal standard to this proposed action.

    Estimate of Economic Impact

    I. Summary of Economic Impact. The Department has increased the Evaluation and Management (E&M) procedure codes for physicians from 92 percent to 93 percent of the Medicare rate. The total FY 19 increase in fee for service (FFS) payments equals $800,000. The total FY 19 increase in managed care organization (MCO) payments equals $3,600,000. Total impact for FFS and MCO payments equals $4,400,000.



    Revenue (R+/R-)


    II. Types of Economic Impact.






    A. On issuing agency:



    B. On other State agencies:


    C. On local governments:




    Benefit (+)
    Cost (-)




    D. On regulated industries or trade groups:



    E. On other industries or trade groups:


    F. Direct and indirect effects on public:


    III. Assumptions. (Identified by Impact Letter and Number from Section II.)

    A. This amount assumes:

    (1) An estimated $4,400,000 increase in total funds;

    (2) The State’s (general funds) share of the increased expenditures is 40 percent, or $1,900,000; and

    (3) The federal share is 60 percent, or $2,500,000.

    D. This amount assumes providers who render evaluation and management services will reap a collective benefit of $4,400,000 in increased reimbursement rates.

    Economic Impact on Small Businesses

    The proposed action has a meaningful economic impact on small business. An analysis of this economic impact follows.

    This proposal updates the Professional Services Billing Manual and Fee Schedule to reflect reimbursement rate increases for evaluation and management procedure codes from 92 percent to 93 percent of the Medicare rate. Therefore, it impacts small business providers who render evaluation and management services to fee-for-service Medicaid participants.

    Impact on Individuals with Disabilities

    The proposed action has no impact on individuals with disabilities.

    Opportunity for Public Comment

    Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499, or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through October 29, 2018. A public hearing has not been scheduled.



    Editor’s Note on Incorporation by Reference

         Pursuant to State Government Article, §7-207, Annotated Code of Maryland, the Professional Services Provider Manual and Fee Schedule (Effective July 2018) has been declared a document generally available to the public and appropriate for incorporation by reference.  For this reason, it will not be printed in the Maryland Register or the Code of Maryland Regulations (COMAR).  Copies of this document are filed in special public depositories located throughout the State.  A list of these depositories was published in 45:1 Md. R. 8 (January 5, 2018), and is available online at www.dsd.state.md.us.  The document may also be inspected at the office of the Division of State Documents, 16 Francis Street, Annapolis, Maryland 21401. 

    .07 Payment Procedures.

    A.—C. (text unchanged) 

    D. The Maryland Medical Assistance Program’s procedures for payment are contained in the Professional Services Provider Manual and Fee Schedule (Effective [January 2018July 2018). All the provisions of this document, unless specifically excepted, are incorporated by reference.

    E.—Q. (text unchanged)

    Secretary of Health