MedicaidBilling CodesMedium impact
MAB2023091301
Pennsylvania Medicaid (DHS)·PA · Pediatrics, Family Medicine, Internal Medicine·Provider Bulletin
Effective date
Sep 5, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance expanded Childhood Nutrition and Weight Management Services to include pharmacotherapy for beneficiaries under 21, added new billing codes, and updated telehealth place of service requirements. All obesity drug prescriptions require prior authorization.
Action Required
Immediately: Update billing system to use new procedure code 96156 for childhood nutrition assessments and reassessments for PA Medicaid patients under 21. Remove GT modifier from T1015 and use POS codes 02 (telehealth not in home) or 10 (telehealth in home) for telehealth services. Ensure all obesity drug prescriptions have prior authorization before billing. Update encounter forms to reflect new coding requirements.