MedicaidReimbursementMedium impact
MAB2020091501
Pennsylvania Medicaid (DHS)·PA · Ophthalmology, Optometry·Provider Bulletin
Effective date
Oct 1, 2020
We identified it
Jun 20, 2026
Summary
Starting October 1, 2020, Pennsylvania FQHCs and RHCs can receive separate PPS encounter payments for vision services provided by ophthalmologists or optometrists using T1015 with U3 modifier. This is in addition to physical health, behavioral health, and dental encounters on the same day.
Action Required
Before October 1, 2020: FQHCs and RHCs must submit MA FQHC Cost Report to Department of Human Services to establish vision PPS encounter rate. Update billing system to use T1015 with U3 pricing modifier for vision encounters provided by ophthalmologists or optometrists. Note: Beneficiaries 21+ are limited to two optometrist encounters per calendar year.