MedicaidBilling CodesHigh impact
MAB2023083101
Pennsylvania Medicaid (DHS)·PA · General Surgery, Plastic Surgery, ENT (Ear, Nose & Throat) +5 more·Provider Bulletin
Effective date
Sep 5, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing 2023 HCPCS updates effective September 5, 2023, adding new billing codes with prior authorization requirements, end-dating obsolete codes, and adjusting fees for existing codes. The changes affect multiple specialties including surgery, laboratory, dental, and durable medical equipment services.
Action Required
By September 5, 2023: Billing team must update PA Medicaid billing system to add new codes and require prior authorization for codes 84433, A4453, A4459, D4342, E0183, E0766, and K0455. Stop billing end-dated codes (49560-49657, 99217-99343, K0553-K0554) for new services after this date but continue using them for previously authorized services through September 5, 2024. Update fee schedules for laboratory code 81243 (reduce from $93.14 to $45.63) and medical supply codes A4224, A4351-A4353, A4362 with new rates and unit limits. Providers must obtain prior authorization before billing the specified codes or claims will be denied.