Summary
Effective for dates of service on and after June 1, 2023, Pennsylvania Medical Assistance end-dated a list of E&M procedure codes and updated code descriptions and fees to match the 2023 HCPCS updates. The Department opened or closed specific provider type, specialty and place of service combinations for many codes, and added the TH modifier for prenatal or postpartum obstetric evaluation and management services on specified codes. Fees changed across many hospital, office, emergency, nursing facility and home visit codes, for example 99223 went from $156.63 to $135.92 and 99236 went from $111.46 to $163.65.
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What to do
Action · 8 steps
01Already effective June 1, 2023: Billing team: for dates of service on and after June 1, 2023, do not bill the E&M codes the Department end-dated, including 99217 through 99220, 99224 through 99226, 99241, 99251, 99281, 99318, 99324 through 99328, 99334 through 99337 and 99343.
02For inpatient or observation consultations, use 99252 through 99255.
03For nursing facility services, use the nursing facility codes instead of POS 31 and POS 32 for 99252 through 99255.
04Check the place of service, modifier and provider type combinations in the attached fee schedule before billing, including: add the TH modifier for prenatal or postpartum obstetric visits with 99234, 99235, 99236, 99239, 99344 and 99345; add Q6 with U4 or U5 for 99283 in emergency rooms; and add POS 10 for telehealth provided in the patient's home for the listed codes, while POS 02 is end-dated for the listed codes.
05Confirm the new fees on the MA Program Fee Schedule, for example 99223 changed from $156.63 to $135.92.
06Observe the service limits in the fee table, such as one per 180 days for 99483; when a service is needed beyond a limit, the provider may request a waiver through the Department's 1150 Administrative Waiver Program Exception process.
07For managed care members, send coding or billing questions to the managed care organization.
08Fee-for-Service Provider Service Center: 1-800-537-8862.
Codes mentioned
990509920299203992049920599211992129921399214992159921799218992199922099221992229922399224992259922699231992329923399234992359923699238992399924199242992439924499245992519925299253992549925599281992829928399284992859929199292993049930599306993079930899309993109931599316993189932499325993269932799328993349933599336993379934199342993439934499345993479934899349993509936099381993829938399384993859938699387993919939299393993949939599396993979940199407994609946199462994639946899469994719947299475994769947799478994799948099483994849949199492994939949499501T1015
Original notice
MAB2023060101
pa.gov · Always check the source before changing claims.
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