When does this change take effect?

This change is effective Aug 29, 2022.

MedicaidBilling CodesMedium impact

MAB2022082602

Q: Who is affected by this change?

This affects Pennsylvania Medicaid (DHS) Orthopedics, Anesthesiology, Neurosurgery, Ophthalmology, ENT (Ear, Nose & Throat), General Surgery +6 more providers in PA on Medicaid plans.

Q: Which billing codes are affected?

The following codes are affected: 01937, 01938, 01939, 01940, 01941, 01942, 63052, 63053, 66989, 66991, 68841, 69716, 69719, 69726, 69727, 82653, 83521, 86015, 86036, 86037, 86051, 86052, 86053, 86231, 86362, 86363, 86596, 90626, 90627, 90671, 90677, 90759, 93319, 93593, 93594, 93595, 93596, 93597, 93598, 99424, 99426, D3921, D9947, D9948, D9949, G1028, 52441, 52442, 81415, 81417, 90587, 93325, 95800, B4105, D4346, L8619, L8692, L8694, Q4186, 01935, 01936, 21310, 33470, 33722, 43850, 43855, 59135, 63194, 63195, 63196, 63198, 63199, 69715, 69718, 76101, 76102, 92561, 92564, 93530, 93531, 93532, 93533, 93561, 93562, G2064, G2065, G2215, 27078, 27140, 27147, 27151, 27226, 27227, 27228, 27245, 27405, 27407, 27507, 27514, 29826, 49491, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99281, 99282, 99283, 99284, 99285, T1015, 90792, 90832, 90834, 90837, 90846, 90847, 90853, 90870, 90875, 96116, 96121, 96127, 96130, 96131, 96132, 96133, 96136, 96137, 96160, 99241, H0034, H2010, H0014.

Pennsylvania Medicaid (DHS)·PA · Orthopedics, Anesthesiology, Neurosurgery +9 more·Provider Bulletin

Effective date

Aug 29, 2022

We identified it

Jun 20, 2026

Days to comply

—

Summary

Pennsylvania Medical Assistance (Medicaid) is implementing 2022 HCPCS code updates effective August 29, 2022, adding new procedure codes, end-dating others, and establishing prior authorization requirements for specific codes including genetic testing, prosthetics, and dental procedures.

Action Required

Action needed

By August 29, 2022: Billing team must update PA Medicaid billing to use new procedure codes and obtain prior authorization for codes 81415, 81417, B4105, Q4186, D3921, D9947, L8619, L8692, L8694. Stop billing end-dated codes (including 01935, 01936, 21310, 33470, 33722, 43850, 43855, 59135, 63194-63199, 69715, 69718, 76101-76102, 92561, 92564, 93530-93533, 93561-93562, G2064, G2065). Update billing software to accept new HCPCS codes and require prior auth for specified procedures. Claims with end-dated codes will be rejected after August 29, 2023 unless previously authorized.

Affected Billing Codes

01937

01938

01939

01940

01941

01942

63052

63053

66989

66991

68841

69716

69719

69726

69727

82653

83521

86015

86036

86037

86051

86052

86053

86231

86362

86363

86596

90626

90627

90671

90677

90759

93319

93593

93594

93595

93596

93597

93598

99424

99426

D3921

D9947

D9948

D9949

G1028

52441

52442

81415

81417

90587

93325

95800

B4105

D4346

L8619

L8692

L8694

Q4186

01935

01936

21310

33470

33722

43850

43855

59135

63194

63195

63196

63198

63199

69715

69718

76101

76102

92561

92564

93530

93531

93532

93533

93561

93562

G2064

G2065

G2215

27078

27140

27147

27151

27226

27227

27228

27245

27405

27407

27507

27514

29826

49491

99202

99203

99204

99205

99211

99212

99213

99214

99215

99281

99282

99283

99284

99285

T1015

90792

90832

90834

90837

90846

90847

90853

90870

90875

96116

96121

96127

96130

96131

96132

96133

96136

96137

96160

99241

H0034

H2010

H0014

Related policy hubs

Pennsylvania Medicaid (DHS) policies PA policy changes Orthopedics Anesthesiology Neurosurgery Ophthalmology ENT (Ear, Nose & Throat)General Surgery Cardiology Pathology Dentistry Genetics Psychiatry General Practice Code 01937 Code 01938 Code 01939 Code 01940 Code 01941 Code 01942 Code 63052 Code 63053 Code 66989 Code 66991 Code 68841 Code 69716 Code 69719 Code 69726 Code 69727 Code 82653 Code 83521 Code 86015 Code 86036 Code 86037 Code 86051 Code 86052 Code 86053 Code 86231 Code 86362 Code 86363 Code 86596 Code 90626 Code 90627 Code 90671 Code 90677 Code 90759 Code 93319 Code 93593 Code 93594 Code 93595 Code 93596 Code 93597 Code 93598 Code 99424 Code 99426 Code D3921 Code D9947 Code D9948 Code D9949 Code G1028 Code 52441 Code 52442 Code 81415 Code 81417 Code 90587 Code 93325 Code 95800 Code B4105 Code D4346 Code L8619 Code L8692 Code L8694 Code Q4186 Code 01935 Code 01936 Code 21310 Code 33470 Code 33722 Code 43850 Code 43855 Code 59135 Code 63194 Code 63195 Code 63196 Code 63198 Code 63199 Code 69715 Code 69718 Code 76101 Code 76102 Code 92561 Code 92564 Code 93530 Code 93531 Code 93532 Code 93533 Code 93561 Code 93562 Code G2064 Code G2065 Code G2215 Code 27078 Code 27140 Code 27147 Code 27151 Code 27226 Code 27227 Code 27228 Code 27245 Code 27405 Code 27407 Code 27507 Code 27514 Code 29826 Code 49491 Code 99202 Code 99203 Code 99204 Code 99205 Code 99211 Code 99212 Code 99213 Code 99214 Code 99215 Code 99281 Code 99282 Code 99283 Code 99284 Code 99285 Code T1015 Code 90792 Code 90832 Code 90834 Code 90837 Code 90846 Code 90847 Code 90853 Code 90870 Code 90875 Code 96116 Code 96121 Code 96127 Code 96130 Code 96131 Code 96132 Code 96133 Code 96136 Code 96137 Code 96160 Code 99241 Code H0034 Code H2010 Code H0014