MedicaidBilling CodesMedium impact
MAB2024021301
Pennsylvania Medicaid (DHS)·PA · Pharmacy, Family Medicine, General Practice +1 more·Provider Bulletin
Effective date
Mar 1, 2024
We identified it
Jun 20, 2026
Summary
Effective March 1, 2024, Pennsylvania Medical Assistance (Medicaid) is changing how pharmacists bill for medical services - they must now enroll as Provider Type 10 (Mid-Level Practitioner) instead of Provider Type 24 (Pharmacy). New medication therapy management codes and specific vaccine administration codes are being added to the fee schedule.
Action Required
By February 29, 2024: Pharmacists providing medical services must re-enroll as Provider Type 10/Specialty 247 (Mid-Level Practitioner) instead of Provider Type 24/Specialty 247 (Pharmacy). Billing team must update system to use new medication therapy management codes (99605, 99606, 99607) and discontinue use of non-specific vaccine administration codes 90471 and 90472. Update billing procedures to use specific vaccine administration codes listed in the policy.