MedicaidBilling CodesHigh impact
MAB2023060101
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Internal Medicine, Pediatrics +5 more·Provider Bulletin
Effective date
Jun 1, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance program has end-dated 21 E&M procedure codes and made extensive changes to provider type/place of service combinations for remaining E&M codes, including adding new home visit codes and expanding inpatient/observation billing options. Multiple provider types including physicians, nurse practitioners, physician assistants, and specialists have updated billing privileges.
Action Required
Immediately: Update billing system to stop using end-dated E&M codes (99217, 99218, 99219, 99220, 99224, 99225, 99226, 99241, 99251, 99281, 99318, 99324-99328, 99334-99337, 99343) for Pennsylvania Medicaid claims. Update provider type and place of service combinations for remaining E&M codes per the bulletin specifications. Add TH modifier capability for obstetric services. Train billing staff on new home visit codes 99344-99345 and updated inpatient/observation billing rules. Failure to comply will result in claim denials.