MedicaidBilling CodesMedium impact
MAB2025123003
Pennsylvania Medicaid (DHS)·PA · Family Medicine, OB-GYN, General Practice·Provider Bulletin
Effective date
Dec 30, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance updated the Family Planning Services Program fee schedule, adding new procedure codes 87521 and 87626, end-dating S4989, and increasing reimbursement rates for contraceptive devices (J7296-J7307). Laboratory procedure codes 87490 and 87492 are now limited to once per day instead of twice per day.
Action Required
By December 30, 2025: Billing team must update Pennsylvania Medicaid billing to add new codes 87521 and 87626 with FP modifier, stop billing S4989 (end-dated May 1, 2025), update fee schedules for contraceptive devices J7296-J7307 with new higher rates, and limit laboratory codes 87490 and 87492 to once per day maximum. Ensure all family planning services use the FP modifier for proper reimbursement.