MedicaidPrior AuthHigh impact
MAB2021043001
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Jul 1, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is reinstating prior authorization requirements for multiple services that were suspended during COVID-19, including inpatient hospital admissions, home health, skilled nursing facilities, medical supplies/DME, and specific chest CT scans. The prior auth requirements that were in place on February 29, 2020 will be restored effective July 1, 2021.
Action Required
By July 1, 2021: Billing team must reinstate prior authorization requirements for Pennsylvania Medicaid Fee-for-Service patients for inpatient hospital admissions, home health services, inpatient rehabilitation, skilled nursing facilities, medical supplies/DME, and chest CT scans (CPT 71250, 71260, 71270). Update billing system to flag these services for prior auth verification. Exception: Shift care services (S9122, S9123, S9124) for children under 21 remain suspended. Claims submitted without required prior authorization will be denied.