MedicaidPrior AuthMedium impact
MAB2026033002
Pennsylvania Medicaid (DHS)·PA · Podiatry, Orthopedics, Family Medicine +2 more·Provider Bulletin
Effective date
Mar 30, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for ALL prescriptions of removable, pre-molded arch supports effective March 30, 2026. New clinical guidelines specify required documentation including gait analysis, physical examination findings, and proof that conservative treatments failed.
Action Required
Immediately: Update billing workflows to obtain prior authorization for ALL removable, pre-molded arch support prescriptions for Pennsylvania Medicaid patients. Providers must document: 1) Gait analysis showing abnormal foot mechanics, 2) Physical exam findings (arch collapse, tenderness, callus formation), 3) Specific qualifying diagnoses (plantar fasciitis, flat feet, overpronation, metatarsalgia, diabetic foot complications, or arthritis), 4) Failed conservative treatments (rest/ice, physical therapy, OTC insoles). Submit requests through PROMISe system with complete clinical documentation. Claims will be denied without proper prior authorization.