MedicaidPrior AuthHigh impact
MAB2026033003
Pennsylvania Medicaid (DHS)·PA · Orthopedics, PM&R (Physical Medicine & Rehab), Neurosurgery +2 more·Provider Bulletin
Effective date
Mar 30, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance now requires prior authorization for all thoracic-lumbar-sacral orthoses (TLSO) prescriptions effective immediately. New clinical guidelines specify documentation requirements including medical diagnosis, functional assessments, and proof that other devices were inadequate.
Action Required
Immediately: All providers prescribing TLSO must obtain prior authorization before ordering. Submit required documentation including medical diagnosis, physical therapy assessments, X-ray reports, functional level documentation, and proof other devices were tried. Durable medical equipment suppliers must verify prior authorization before dispensing TLSO to Pennsylvania Medicaid beneficiaries. Claims without prior authorization will be denied.