Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Pennsylvania Medicaid (DHS)Medicaid · Coverage · Provider Bulletin · PA · Pediatrics, Family Medicine, Bariatric Surgery +1 moreMedium impact

MAB2023091301

Effective date
Sep 5, 2023
Identified
Jun 20, 2026

Summary

Effective for services rendered on and after September 5, 2023, Childhood Nutrition and Weight Management Services (CNWMS) for Pennsylvania Medical Assistance beneficiaries under 21 years of age now include pharmacotherapy, and bariatric surgery is covered under EPSDT and requires prior authorization. The MA Program adds POS 10 (Telehealth Provided in a Patient's Home) to all CNWMS-related procedure codes on the fee schedule, and the GT modifier is removed from procedure code T1015. All prescriptions for obesity drugs require prior authorization under MA bulletin 01-22-70.

Get alerts when payers change rules like this one

We check Pennsylvania Medicaid (DHS) and other payers every day and email you when a change matches your specialty and state.

Get Pennsylvania Medicaid (DHS) alertsPolicy Monitoring is free. No card required.

What to do

Action · 8 steps
01Already effective September 5, 2023: Providers must document the medical necessity for any CNWMS in the child's medical record, in accordance with 55 Pa.
02Code § 1101.51.
03Use the updated chart attached to the bulletin for CNWMS services rendered on and after September 5, 2023.
04Bariatric surgery requires prior authorization.
05All prescriptions for obesity drugs require prior authorization, and providers should refer to MA bulletin 01-22-70 for those requirements.
06The Department encourages providers to ensure that the child has had a recent EPSDT screening or physical exam, as appropriate, to support the medical necessity of the initial assessment, re-assessment and additional CNWMS.
07For telehealth, use POS 10 with the CNWMS-related procedure codes on the updated chart, and note that the GT modifier was removed from procedure code T1015.
08The bulletin obsoletes MA Bulletin 01-18-09 and MA Bulletin 01-20-06.

Codes mentioned

96156961589615996164961659616796168S9470T1015

Original notice

MAB2023091301
pa.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Pennsylvania Medicaid (DHS) changes →
MAB2020052603MediumEffective May 26, 2020 · Provider BulletinMAB2023083101MediumEffective Sep 5, 2023 · Provider BulletinMAB2020052601MediumEffective May 26, 2020 · Provider BulletinMAB2024090901HighEffective Sep 9, 2024 · Provider BulletinBrowse every Pennsylvania Medicaid (DHS) change in the policy list

Related policy hubs

Pennsylvania Medicaid (DHS) policiesPA policy changesPediatricsFamily MedicineBariatric SurgeryPharmacyCode 96156Code 96158Code 96159Code 96164Code 96165Code 96167Code 96168Code S9470Code T1015

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account