MedicaidPrior AuthMedium impact
mab2025091902
Pennsylvania Medicaid (DHS)·PA · Audiology, ENT (Ear, Nose & Throat), Pediatrics·Provider Bulletin
Effective date
Sep 19, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance now requires prior authorization for all wearable air conduction hearing aids prescribed to beneficiaries under 21 years old, effective immediately. Coverage is completely excluded for beneficiaries 21 years and older.
Action Required
Immediately: Billing team must implement prior authorization requirements for all wearable air conduction hearing aid prescriptions for Pennsylvania Medicaid beneficiaries under 21. Update billing system to flag these cases and require audiologist evaluation, medical diagnosis, audiogram, and hearing assessment documentation before submission. Stop billing for beneficiaries 21+ as coverage is excluded. Claims without prior authorization will be denied.