MedicaidPrior AuthMedium impact
MAB2021111701
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Nephrology, Gastroenterology +2 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for growth hormones, adding nephrologist as an approved prescribing specialist and revising medical necessity guidelines including changes to small for gestational age definitions and imaging requirements for different age groups.
Action Required
By January 3, 2022: Billing team must update prior authorization procedures for growth hormone prescriptions to include nephrologist as approved prescribing specialist alongside endocrinologist, gastroenterologist, and neonatologist. Review and update documentation requirements for small for gestational age cases and imaging requirements for pediatric beneficiaries. Ensure all growth hormone prior auth requests include revised medical necessity criteria.