MedicaidBilling CodesMedium impact
MAB2023032801
Pennsylvania Medicaid (DHS)·PA · Radiation Oncology, OB-GYN, Urology +2 more·Provider Bulletin
Effective date
Apr 1, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is adding 6 new procedure codes including proton therapy and retinal imaging to their fee schedule, with 4 proton therapy codes requiring prior authorization. The policy also updates existing codes and reduces the fee for one wound care product.
Action Required
By April 1, 2023: Billing team must update system to require prior authorization for proton therapy codes 77520, 77522, 77523, and 77525 for Pennsylvania Medicaid patients. Update fee schedule to reflect new codes and reduced fee for Q4186 from $242.96 to $157.64. Add new modifier combinations for codes 58674, 52441, 52442, and E1800. For E1800 with RR modifier, prior auth is required after 3 months of rental.