MedicaidBilling CodesMedium impact
MAB2024042901
Pennsylvania Medicaid (DHS)·PA · Cardiology, Family Medicine, Internal Medicine +2 more·Provider Bulletin
Effective date
Apr 29, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has updated their fee schedule effective April 29, 2024, adding new cardiovascular monitoring codes (93242, 93243, 93244), removing prior authorization for genetic testing code 81511, and expanding provider type/place of service combinations for laboratory tests and vaccine administration codes.
Action Required
Immediately: Update billing system to include new cardiovascular monitoring codes 93242, 93243, and 93244 for Pennsylvania Medicaid claims. Remove prior authorization requirements for genetic testing code 81511. Review and update provider type/place of service combinations for laboratory and vaccine administration codes to ensure proper billing for certified nurse midwives, clinics, and other affected providers. Verify current provider enrollment revalidation dates in PROMISe system and submit applications at least 60 days before expiration.