Summary
Pennsylvania Medical Assistance added, end-dated and changed procedure codes on its fee schedule to implement the 2021 HCPCS updates, effective for dates of service on and after August 23, 2021. Several advanced radiology codes, certain dental codes and other newly added codes require prior authorization. The changes also removed the GT modifier for telemedicine on certain E/M codes in favor of place of service 02, added naloxone take-home add-on codes G2215 and G2216, and changed fees for E/M codes 99221 through 99233 and breast pump code E0603.
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What to do
Action · 8 steps
01Already effective August 23, 2021: Billing team should check current applicability before completing any of these past requirements.
02Get prior authorization before scheduling advanced radiology codes 71271, 81168 and 81279 (the process is described in MA Bulletin 01-14-42), and before scheduling dental codes D3471, D3472, D3473, D3501, D3502 and D3503 with or without the SG modifier.
03No new authorizations were issued for the end-dated procedure codes on and after August 23, 2021.
04For services with a prior authorization issued before that date, submit claims using the end-dated code as set forth in that authorization, which the Department accepted until August 23, 2022.
05When take-home naloxone is dispensed, use G2215 or G2216 in addition to the open E/M or T1015 code.
06For E/M codes 99221, 99222, 99223, 99231, 99232, 99233 and 99241, the GT modifier was removed and POS 02 identifies telemedicine services.
07For breast pump E0603 (NU), the limit changed to once per calendar year, prior authorization is still required for purchase, and the fee is $180.00.
08For managed care members, direct billing questions to the managed care organization.
Codes mentioned
304683240833741337453374671271801898116881279926509265192652926539461987510904719047293351A9274D1321D2503D3471D3472D3473D3501D3502D3503D7961D7962D7960G2213G2214G2215G2216G02971930719324193662748632405492205711258293618706216363055631806318269605769707813587480876608766192585925869299292993942509440094750947709507199201992029920399204992059921199212992139921499215992219922299223992319923299233992419928199282992839928499285T1015E0603
Original notice
MAB2021082001
pa.gov · Always check the source before changing claims.
Related changes
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Related policy hubs
Pennsylvania Medicaid (DHS) policiesPA policy changesRadiologyDentistryCardiologyENT (Ear, Nose & Throat)AudiologyPharmacyInternal MedicineGeneral PracticePsychiatryPulmonologyOrthopedicsOB-GYNCode 30468Code 32408Code 33741Code 33745Code 33746Code 71271Code 80189Code 81168Code 81279Code 92650Code 92651Code 92652Code 92653Code 94619Code 87510Code 90471Code 90472Code 93351Code A9274Code D1321Code D2503Code D3471Code D3472Code D3473Code D3501Code D3502Code D3503Code D7961Code D7962Code D7960Code G2213Code G2214Code G2215Code G2216Code G0297Code 19307Code 19324Code 19366Code 27486Code 32405Code 49220Code 57112Code 58293Code 61870Code 62163Code 63055Code 63180Code 63182Code 69605Code 76970Code 78135Code 87480Code 87660Code 87661Code 92585Code 92586Code 92992Code 92993Code 94250Code 94400Code 94750Code 94770Code 95071Code 99201Code 99202Code 99203Code 99204Code 99205Code 99211Code 99212Code 99213Code 99214Code 99215Code 99221Code 99222Code 99223Code 99231Code 99232Code 99233Code 99241Code 99281Code 99282Code 99283Code 99284Code 99285Code T1015Code E0603