Summary
Pennsylvania Medical Assistance Bulletin 99-25-07 revised the MA fee-for-service fee schedule. All of its changes carry effective dates between September 10, 2025 and January 1, 2026. Prior authorization applies to L0720, L1933, L1952, L6028, L6029, L6030, L6032, L6033, L6037, E1032 (NU), E1033 (NU), E1034 (NU), E2398, G0562 and G0563, and the codes A9155, E0575 and M0248 were end-dated effective November 30, 2025.
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What to do
Action · 11 steps
01Already effective for dates of service on and after November 30, 2025: Stop billing A9155, E0575 (NU), E0575 (RR) and M0248 because they were end-dated from the fee schedule.
02Stop using the U8 pricing modifier on K0108 for the listed provider type, specialty and place of service combinations.
03Already effective for dates of service on and after December 1, 2025: Get prior authorization before scheduling L0720, L1933 (LT and RT), L1952 (LT and RT), L6028, L6029, L6030, L6032, L6033 and L6037 (LT and RT), E1032 (NU), E1033 (NU), E1034 (NU) and E2398.
04Initiate the telephonic prior authorization request for G0562 (including TC and 26 modifiers) and G0563 as described in Provider Quick Tip #41, Medical Assistance Desk Reference.
05Check the attachment for the provider type, specialty, place of service, modifier, units, limits and prior authorization requirement listed for each code.
06For 87490 and 87492 the units changed from a 1:2 minimum to maximum ratio to a 1:1 ratio.
07For 37765 and 37766 the post-op days changed from 90 to 10, and for 77750, 77761, 77762 and 77763 the post-op days changed from 0 to 90.
08When a service exceeds an established limit, request a waiver through the 1150 Administrative Waiver Program Exception process.
09Already effective for dates of service on and after January 1, 2026: The codes A4295, A4296 and A4297 were added to the fee schedule with a limit of 200 intermittent urinary catheters per calendar month.
10Providers should log into PROMISe to check the revalidation date of each service location and submit revalidation applications at least 60 days before those dates.
11All dates in this bulletin have passed as of 2026-11-05, so check current applicability in the online MA fee schedule before taking any of these steps.
Codes mentioned
9062490382876269132399377E2398A4295A4296A4297A9154E1022E1023E1032E1033E1034G0562G0563L0720L1933L1952L6028L6029L6030L6032L6033L60378749087491874928756387591876348780799473996059960699607377653776677750777617776277763A9155E0575M0248K0108
Original notice
mab2025111301
pa.gov · Always check the source before changing claims.
Related changes
See all Pennsylvania Medicaid (DHS) changes →MAB2025123003MediumEffective Dec 30, 2025 · Provider BulletinMAB2024052802MediumEffective May 28, 2024 · Provider BulletinMAB2025021801MediumEffective Feb 18, 2025 · Provider BulletinMAB2024021301HighEffective Mar 1, 2024 · Provider BulletinBrowse every Pennsylvania Medicaid (DHS) change in the policy list
Related policy hubs
Pennsylvania Medicaid (DHS) policiesPA policy changesOrthopedicsPM&R (Physical Medicine & Rehab)Physical TherapyPathologyInfectious DiseasePharmacyRadiation OncologyVascular SurgeryOB-GYNPediatricsFamily MedicinePalliative CareCode 90624Code 90382Code 87626Code 91323Code 99377Code E2398Code A4295Code A4296Code A4297Code A9154Code E1022Code E1023Code E1032Code E1033Code E1034Code G0562Code G0563Code L0720Code L1933Code L1952Code L6028Code L6029Code L6030Code L6032Code L6033Code L6037Code 87490Code 87491Code 87492Code 87563Code 87591Code 87634Code 87807Code 99473Code 99605Code 99606Code 99607Code 37765Code 37766Code 77750Code 77761Code 77762Code 77763Code A9155Code E0575Code M0248Code K0108