MedicaidReimbursementMedium impact
MAB2024101601
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Internal Medicine, Pediatrics·Provider Bulletin
Effective date
Oct 1, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania continues the alternative payment methodology allowing FQHCs and RHCs to bill at Medical Assistance Fee Schedule rates (instead of their usual PPS rates) for COVID-19 vaccine-only visits. This policy extends the higher reimbursement rate that was set to expire September 30, 2024.
Action Required
FQHCs and RHCs already opted into the APM continue automatically - no action needed. New participants must opt-in by having their Chief Financial Officer email RA-PWOMAPFQHC-RHC@pa.gov with 9-digit provider ID and 4-digit service location number at least 10 business days before submitting claims. For COVID vaccine-only visits, bill specific SARS-CoV-2 vaccine CPT codes from MA Fee Schedule. When vaccine given with other services, bill T1015 for PPS rate plus vaccine code on separate line for tracking.