MedicaidBilling CodesMedium impact
MAB2021051801
Pennsylvania Medicaid (DHS)·PA · Emergency Medicine, Family Medicine, General Practice +2 more·Provider Bulletin
Effective date
Nov 2, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has added two new COVID-19 antigen test CPT codes (87426 and 87811) to their fee schedule, effective retroactively to November 2, 2020. These codes can now be billed to Pennsylvania Medical Assistance with specified reimbursement rates and no prior authorization required.
Action Required
Immediately: Billing team should verify that CPT codes 87426 ($34.94) and 87811 ($11.51) are active in billing system for Pennsylvania Medicaid claims with dates of service on or after November 2, 2020. Update fee schedules if needed. No prior authorization required for either code. Ensure proper place of service codes and QW modifier usage as specified in the fee schedule table.