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Pennsylvania Medicaid (DHS)Medicaid · Billing Codes · Provider Bulletin · PA · Dentistry, General Surgery, Urology +5 moreMedium impact

MAB2023083101

Effective date
Sep 5, 2023
Identified
Jun 20, 2026

Summary

Effective for dates of service on and after September 5, 2023, the Pennsylvania Medical Assistance Fee-for-Service program adds 2023 HCPCS procedure codes and modifier combinations to the MA Program Fee Schedule, end-dates a list of procedure codes, and sets prior authorization requirements for some of the added codes. The bulletin also changes unit and service limits, several fees (for example, CPT 81243 changes from $93.14 to $45.63), telehealth place of service rules (POS 10 added to listed codes and POS 02 end-dated for listed codes), and the GT modifier for listed codes. Providers rendering services in the managed care delivery system should direct coding and billing questions to the appropriate managed care organization.

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What to do

Action · 6 steps
01Already effective September 5, 2023: Billing team should get prior authorization for CPT 84433, HCPCS A4453 and A4459, dental code D4342 with modifier SG, E0183 with modifier NU, K0455 with modifier NU, and E0766 with modifier RR, which requires prior authorization with the first month's rental.
02For E0183 with modifier RR and K0455 with modifier RR, the bulletin requires prior authorization after three months of rental.
03For procedure codes that had a prior authorization issued Previously due September 5, 2023 (date passed; verify current applicability) and are now end-dated, submit claims using the end-dated procedure code as set forth in the authorization issued by the Department.
04The Department accepted claims with those end-dated codes for previously prior authorized services until September 5, 2024, so check current applicability rather than relying on that date.
05Update claims for the telehealth changes so POS 10 (Telehealth Provided in a Patient's Home) is used for the listed codes, stop billing POS 02 for the codes the bulletin end-dates, and stop using the GT modifier on the codes the bulletin end-dates.
06Where a service exceeds an established service limit, providers may request a waiver through the 1150 Administrative Waiver Program Exception (PE) process described in the MA Program Provider Handbook.

Codes mentioned

84433A4453A4459D4342E0183K0455E0766E2103E2102A4224A4351A4352A4353A4362A4239A4238A4670A46638124381445814508145581456874678746887563921369356999292991889947359025D1354D4341D4346D4910D1110D1120D1310D1330D0372D0373D0374D7509D995396156961589615996164961659616796168907919083290853920029200492012920149250792508925219252292523925249711097112971169753097755S9152S9470T1023H0031H0046H2027G0108G0109G9016

Original notice

MAB2023083101
pa.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Pennsylvania Medicaid (DHS) changes →
MAB2020092201MediumEffective Sep 22, 2020 · Provider BulletinMAB2022091501MediumEffective Sep 15, 2022 · Provider BulletinMAB2024091601MediumEffective Sep 16, 2024 · Provider BulletinMAB2025111801MediumEffective Nov 18, 2025 · Provider BulletinBrowse every Pennsylvania Medicaid (DHS) change in the policy list

Related policy hubs

Pennsylvania Medicaid (DHS) policiesPA policy changesDentistryGeneral SurgeryUrologyOB-GYNOphthalmologyEndocrinologyPathologyPediatricsCode 84433Code A4453Code A4459Code D4342Code E0183Code K0455Code E0766Code E2103Code E2102Code A4224Code A4351Code A4352Code A4353Code A4362Code A4239Code A4238Code A4670Code A4663Code 81243Code 81445Code 81450Code 81455Code 81456Code 87467Code 87468Code 87563Code 92136Code 93569Code 99292Code 99188Code 99473Code 59025Code D1354Code D4341Code D4346Code D4910Code D1110Code D1120Code D1310Code D1330Code D0372Code D0373Code D0374Code D7509Code D9953Code 96156Code 96158Code 96159Code 96164Code 96165Code 96167Code 96168Code 90791Code 90832Code 90853Code 92002Code 92004Code 92012Code 92014Code 92507Code 92508Code 92521Code 92522Code 92523Code 92524Code 97110Code 97112Code 97116Code 97530Code 97755Code S9152Code S9470Code T1023Code H0031Code H0046Code H2027Code G0108Code G0109Code G9016

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