MedicaidCoverageMedium impact
MAB2025021801
Pennsylvania Medicaid (DHS)·PA · Family Medicine, General Practice, Pediatrics +1 more·Provider Bulletin
Effective date
Feb 18, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) now covers EPSDT screening, diagnostic, and targeted case management services for eligible juveniles ages 18-25 in carceral settings, effective immediately. These services are billable 30 days prior to release and TCM services continue for at least 30 days post-release.
Action Required
Immediately: Billing team must update system to allow billing of E&M codes 99202-99205 and 99212 for eligible juveniles (ages 18-25) in carceral settings with place of service codes 02, 09, 10, or 11. Verify provider type/specialty combinations match policy requirements. Train staff on TCM service billing for 30 days pre- and post-release periods.