MedicaidPrior AuthMedium impact
MAB2020111007
Pennsylvania Medicaid (DHS)·PA · Orthopedics, Rheumatology, Pain Management·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for intra-articular hyaluronate injections (joint lubricant injections), allowing approval for both knees on initial request instead of requiring separate authorizations. All prescriptions still require prior authorization with documented failure of conservative treatments.
Action Required
By January 5, 2021: Billing team should update prior authorization request procedures for intra-articular hyaluronate injections to note that both knees can now be approved on initial request for Pennsylvania Medicaid patients. Ensure documentation still includes therapeutic failure of non-pharmacologic treatments, acetaminophen/NSAIDs, and intra-articular steroid injections. Providers must still obtain prior authorization for all hyaluronate prescriptions.