MedicaidReimbursementMedium impact
MAB2024091602
Pennsylvania Medicaid (DHS)·PA · Ophthalmology·Provider Bulletin
Effective date
Sep 15, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has increased reimbursement rates for 26 ophthalmology procedure codes, with increases ranging from modest (21% for gonioscopy) to substantial (439% for scar tissue release). These rate increases are designed to improve access to ophthalmology services for Medicaid patients.
Action Required
Immediately: Billing team must update fee schedules in billing system to reflect new Pennsylvania Medicaid rates for the 26 listed ophthalmology codes, effective September 15, 2024. Verify that claims for dates of service on or after September 15, 2024 use the new higher reimbursement amounts. This applies only to Fee-for-Service Medicaid patients, not managed care Medicaid.