MedicaidReimbursementMedium impact
MAB2024070801
Pennsylvania Medicaid (DHS)·PA · Ophthalmology·Provider Bulletin
Effective date
Aug 1, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is increasing reimbursement rates for 6 ophthalmology procedure codes effective August 1, 2024. Fee increases range from significant (92015 increasing from $4.50 to $17.60) to substantial (92235 increasing from $45.50 to $152.10).
Action Required
By August 1, 2024: Billing team must update fee schedules in billing system for Pennsylvania Medical Assistance patients to reflect new reimbursement rates for ophthalmology codes 92004, 92012, 92014, 92015, and 92235 (including TC and 26 modifiers). Verify the updated MA Program Fee Schedule is available on the Pennsylvania DHS website.