MedicaidPrior AuthMedium impact
MAB2026012902
Pennsylvania Medicaid (DHS)·PA · Plastic Surgery, ENT (Ear, Nose & Throat), Oral & Maxillofacial Surgery +1 more·Provider Bulletin
Effective date
Jan 29, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) now requires prior authorization for ALL face and ear prostheses prescriptions, effective immediately. New clinical guidelines and documentation requirements have been established for medical necessity determinations.
Action Required
Immediately: Providers prescribing face and ear prostheses for Pennsylvania Medicaid beneficiaries must obtain prior authorization before dispensing. Submit requests through PROMISe system with required documentation: medical records showing physical impairment, relevant diagnoses, X-ray/MRI reports if appropriate, and PT evaluations if applicable. Claims will be denied without prior authorization.