MedicaidReimbursementMedium impact
MAB2025040301
Pennsylvania Medicaid (DHS)·PA · Family Medicine, OB-GYN, General Practice·Provider Bulletin
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance is implementing a new Alternative Payment Methodology (APM) for FQHCs and RHCs to receive supplemental payments for Long-Acting Reversible Contraceptive (LARC) devices and procedures. Providers can now bill separately for LARC devices and insertion/removal procedures in addition to their regular PPS encounter rate.
Action Required
By April 11, 2025: FQHCs and RHCs must email RA-PWOMAPFQHC-RHC@pa.gov to opt-in to the APM (10 business days before first claim submission). Email must include 9-digit provider ID and 4-digit service location number. Update billing system to bill T1015 for encounters plus separate claim lines for LARC device codes (J7296-J7307) and procedure codes (11976, 11981-11983, 58300-58301) with FP modifier. Notify managed care organizations once APM effective date is confirmed.