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MAB2024090901

Pennsylvania Medicaid (DHS)·PA · Allergy & Immunology, Emergency Medicine, Family Medicine +7 more·Provider Bulletin
Effective date
Sep 9, 2024
We identified it
Jun 20, 2026
Days to comply

Summary

Pennsylvania Medical Assistance (Medicaid) has added new vaccine and procedure codes, removed prior authorization requirements for some codes, updated fee schedules with significant increases for many codes, and revised provider type/place of service combinations effective September 9, 2024.

Action Required

Action needed
Immediately: Update billing system to include new procedure codes (90684, 90653, 90657, 90658, 90660, 90661, 90673, E0604, G2082, G2083, L8033, L8039, S0199, S8427) for PA Medicaid. Remove prior authorization requirements for codes 92065, E0570, E0572, E0574. Add prior authorization requirements for L8033 and L8039. Update fee schedules with new rates - significant increases include 59840 ($81.50 to $765.00), 59841 ($306.00 to $1,000.00), 59856 ($454.94 to $1,000.00), and many others. Update provider type and place of service combinations as specified. Billing team must verify PA Medicaid enrollment revalidation dates in PROMISe system and submit revalidation at least 60 days prior to expiration.

Affected Billing Codes

90684
90653
90657
90658
90660
90661
90673
E0604
G2082
G2083
L8033
L8039
S0199
S8427
92065
E0570
E0572
E0574
65426
99202
99203
99211
99212
99213
G0108
G0109
G0312
G0315
96156
96158
96159
96167
96168
G2214
99452
L8010
L8020
L8030
L8035
L8031
L8032
A4280
L8000
L8001
L8002
L8015
S8424
S8428
59840
59841
59850
59856
90868
90869