MedicaidBilling CodesMedium impact
MAB2024102901
Pennsylvania Medicaid (DHS)·PA · Pediatrics, Family Medicine, General Practice·Provider Bulletin
Effective date
Oct 29, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania updated its EPSDT (Early and Periodic Screening, Diagnosis and Treatment) Program Periodicity Schedule and Coding Matrix effective October 29, 2024. The policy clarifies the required CPT codes, screening procedures, and billing guidance for MA-enrolled providers delivering EPSDT services to beneficiaries from newborn through age 20. There are no coding or recommendation changes from the prior version—this is a reissued schedule with the current AAP guidelines incorporated.
Action Required
By November 28, 2024 (30 days from effective date): Billing team must update billing software and encounter templates to reflect the Pennsylvania EPSDT Periodicity Schedule and Coding Matrix issued October 29, 2024. Verify that all listed CPT codes (99460, 99463, 99381–99385, 99391–99395, 96110, 96127, 96160, 96161, 99173–99177, 92551–92552, 83655, 85013, 85018, 80061) are correctly mapped to the appropriate age ranges and service types per the attached schedule. Ensure providers understand that only ONE CPT code should be reported per service (except immunizations, which may require multiple codes). Confirm that all MA-enrolled service locations are revalidated in PROMISe; revalidation must be completed at least 60 days prior to each location's 5-year revalidation date. Train providers to reference the CDC ACIP immunization schedule for all EPSDT visits and to complete all required screening components listed in the schedule for a 'complete screen' to be billed. Failure to use correct codes and complete required screenings will result in claim denials or downcoding.