MedicaidPrior AuthMedium impact
MAB2026020601
Pennsylvania Medicaid (DHS)·PA · ENT (Ear, Nose & Throat), Speech Therapy, Pulmonology +1 more·Provider Bulletin
Effective date
Feb 6, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for all tracheostomy speaking valves and voice prosthetic devices, with specific medical necessity criteria including speech therapy evaluation, cognitive assessment, and clinical stability requirements.
Action Required
Effective February 6, 2026: Billing team and providers must obtain prior authorization through PROMISe system for all tracheostomy speaking valves and voice prosthetic devices for Pennsylvania Medicaid patients. Submit required documentation including speech therapy evaluation, cognitive assessment, respiratory status, and tracheostomy/laryngectomy diagnosis. Claims will be denied without proper prior authorization.