MedicaidPrior AuthHigh impact
MAB2022070101
Pennsylvania Medicaid (DHS)·PA · Pediatrics, Family Medicine·Provider Bulletin
Effective date
Nov 1, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is reinstating prior authorization requirements for shift care services (codes S9122, S9123, S9124) provided to beneficiaries under age 21, effective November 1, 2022. Providers must submit authorization requests using form MA 97 before the effective date or current authorization expires.
Action Required
By November 1, 2022: Billing team must update system to require prior authorization for codes S9122, S9123, and S9124 for all beneficiaries under age 21. Submit form MA 97 with supporting documentation before current authorization expires or by the effective date. Contact MCOs separately for managed care patients. Claims will only be paid after prior authorization approval.