MedicaidCoverageMedium impact
MAB2022020101
Pennsylvania Medicaid (DHS)·PA · Pharmacy·Provider Bulletin
Effective date
Aug 30, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) now covers FDA-authorized over-the-counter COVID-19 at-home tests through enrolled pharmacies using procedure code T1999, with payment of $11.51 per test and a limit of 8 tests per month per beneficiary.
Action Required
Immediately: Pharmacies enrolled in Pennsylvania Medicaid should update billing systems to use procedure code T1999 for OTC COVID-19 tests with $11.51 reimbursement rate and 8 tests per month limit. Must identify specific product in 'remarks' field. For beneficiaries who paid out-of-pocket between August 30, 2021 and February 1, 2022, provide refunds and bill Medicaid with appropriate service dates. Contact MCOs directly for managed care billing procedures.