MedicaidBilling CodesHigh impact
MAB2021082001
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Aug 23, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing 2021 HCPCS updates effective August 23, 2021, adding new procedure codes, end-dating obsolete codes, and significantly increasing fees for hospital evaluation and management codes (99221-99233). Several new codes require prior authorization, and telemedicine modifier requirements are changing.
Action Required
By August 23, 2021: Billing team must update system with new procedure codes and obtain prior authorization for codes 71271, 81168, 81279, and all D3471-D3503 dental codes. Update fee schedule with new hospital E&M rates (99221: $79.00, 99222: $106.37, 99223: $156.63, 99231: $30.06, 99232: $56.20). Remove GT modifier for hospital E&M codes and use POS 02 for telemedicine instead. Stop billing end-dated codes after August 23, 2021 unless previously authorized.