Summary
The Department updated the Medical Assistance fee schedule for certain family planning and family planning-related procedure codes. The new fees apply to dates of service on or after July 1, 2024, and they also apply to the Family Planning Services Program. For example, IUD insertion code 58300 rose from $67.60 to $366.78, and office visit code 99213 rose from $63.14 to $116.48.
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What to do
Action · 6 steps
01Already effective 2024-07-01: For family planning and family planning-related services in the MA Fee-for-Service system, the updated fees apply to codes 11981, 11982, 11983, 58300, 58301, 99202, 99203, 99212, 99213, 99214, 99385 and 99386 for dates of service on or after July 1, 2024.
02For Family Planning Services Program beneficiaries, use the Family Planning Services Program: Covered Services Chart effective July 1, 2024, which is attached to the bulletin.
03Where the chart says the provider type must bill with the FP modifier or with ICD-10 DX Z30.011 through Z30.9, bill with one of them.
04Providers rendering services in the MA Managed Care delivery system should send coding or billing questions to the appropriate managed care organization; other questions can go to the Fee-for-Service Provider Service Center at 1-800-537-8862.
05The Department will reprocess claims for dates of service on or after July 1, 2024 that were processed before the bulletin was issued.
06Also, all providers must revalidate the MA enrollment of each service location every 5 years, and should check the revalidation dates in PROMISe and submit revalidation applications at least 60 days before those dates.
Codes mentioned
119811198211983583005830199202992039921299213992149938599386
Original notice
MAB2024090902
pa.gov · Always check the source before changing claims.
Related changes
See all Pennsylvania Medicaid (DHS) changes →MAB 01-16-33 MA Program Fee Schedule Updates for Certain Family Planning ServicesMediumEffective Dec 1, 2016 · ReimbursementMAB2024052802MediumEffective May 28, 2024 · Provider BulletinMAB2023060101MediumEffective Jun 1, 2023 · Provider BulletinMAB2025021801MediumEffective Feb 18, 2025 · Provider BulletinBrowse every Pennsylvania Medicaid (DHS) change in the policy list