MedicaidBilling CodesLow impact
MAB2025112001
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Family Medicine, Pediatrics·Provider Bulletin
Effective date
Oct 12, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has established new billing procedures for Targeted Case Management services provided to eligible juveniles (under 21 or former foster youth 18-25) within 30 days before and at least 30 days after release from correctional facilities. New provider specialty 233 (Targeted Case Manager) and procedure code G9012 are now available for physical health and behavioral health case management services.
Action Required
Providers serving eligible juveniles in correctional settings: Enroll under new Provider Type 21 (Case Manager)/Specialty 233 if not already enrolled as another provider type. Billing team must configure system to use procedure code G9012 with Place of Service 09 (Prison/Correctional Facility) for pre-release targeted case management services. Update billing software to recognize PT/Spec combinations: 09/233/09, 10/233/09, 21/233/09, and 31/233/09.