MedicaidCoverageMedium impact
MAB2023062701
Pennsylvania Medicaid (DHS)·PA · Pediatrics, Family Medicine·Provider Bulletin
Effective date
Jun 27, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania's EPSDT program updated HIV screening guidelines to extend the upper age limit from 18 to 21 years and clarified that topical fluoride varnish (CPT 99188) may be applied up to four times per year for beneficiaries ages 0-20. The updated periodicity schedule and coding matrix is now effective for all EPSDT screening services.
Action Required
Immediately: Update EPSDT screening protocols to offer HIV screening for patients ages 15-21 (expanded from previous 15-18 age range). Update billing procedures to allow topical fluoride varnish (CPT 99188) up to four times per year for patients ages 0-20. Replace previous EPSDT periodicity schedules with the June 27, 2023 version attached to this bulletin. Ensure providers use the updated coding matrix for all EPSDT screenings.