MedicaidBilling CodesLow impact
MAB2022012501
Pennsylvania Medicaid (DHS)·PA · Pharmacy·Provider Bulletin
Effective date
Dec 22, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid added procedure code S5001 for pharmacy dispensing of COVID-19 oral antiviral treatments (Paxlovid, molnupiravir) with FDA emergency use authorization. Pharmacies can bill $10.00 dispensing fee using 837P claims, but cannot bill for the medications themselves since they're provided at no cost by the federal government.
Action Required
No action required for most practices. Only PA Medicaid-enrolled pharmacies need to update billing systems to use procedure code S5001 for COVID-19 oral antiviral dispensing fees on 837P claims with $10.00 reimbursement limit of 1 per day. Medical practices prescribing these medications should ensure their NPI is included in the referring provider field on pharmacy claims.