MedicaidReimbursementMedium impact
MAB2021122702
Pennsylvania Medicaid (DHS)·PA · Pediatrics·Provider Bulletin
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is increasing reimbursement rates for private duty/shift nursing services for beneficiaries under 21 years old by $5.00 per hour, from $45.00 to $50.00 per hour for both RN and LPN services.
Action Required
By January 1, 2022: Billing team must update fee schedules in billing system to reflect new rates of $50.00 per hour for CPT codes S9123 and S9124 for Pennsylvania Medicaid patients under 21 years old receiving private duty nursing services. Verify the updated MA Program Outpatient Fee Schedule is loaded into billing software.