Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Pennsylvania Medicaid (DHS)Medicaid · Billing Codes · Provider Bulletin · PA · PediatricsMedium impact

MAB2020052603

Effective date
May 26, 2020
Identified
Jun 20, 2026

Summary

Pennsylvania Medical Assistance updated Childhood Nutrition and Weight Management Services (CNWMS) for MA beneficiaries under 21 to reflect the 2020 Healthcare Common Procedure Coding System updates. Procedure codes 96150, 96151, 96152, 96153 and 96154 were end-dated, and codes 96156, 96158, 96159, 96164, 96165, 96167 and 96168 were added to the MA Program Fee Schedule, effective May 26, 2020. This bulletin supersedes MA Bulletin 01-18-09 and related bulletins titled Childhood Nutrition and Weight Management Services, issued July 3, 2018.

Get alerts when payers change rules like this one

We check Pennsylvania Medicaid (DHS) and other payers every day and email you when a change matches your specialty and state.

Get Pennsylvania Medicaid (DHS) alertsPolicy Monitoring is free. No card required.

What to do

Action · 5 steps
01Already effective May 26, 2020: For CNWMS rendered to MA beneficiaries under 21, document the medical necessity for each service in the child's medical record, in accordance with 55 Pa.
02Code § 1101.51.
03Use the updated Medical Assistance Program Fee Schedule chart attached to the bulletin for services rendered on and after May 26, 2020, which lists the codes, provider types, specialties, place of service, pricing modifiers, MA fees, unit limits and prior authorization for each service.
04Providers who render services in the managed care delivery system should address payment-related questions about CNWMS to the appropriate MA managed care organization.
05Providers are encouraged to confirm that the child had a recent Early and Periodic Screening, Diagnosis and Treatment (EPSDT) screening or physical exam, as appropriate, and primary care providers or others who conduct the initial assessment or re-assessment and order CNWMS are encouraged to coordinate with the provider rendering those services.

Codes mentioned

961509615196152961539615496156961589615996164961659616796168S9470T1015

Original notice

MAB2020052603
pa.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Pennsylvania Medicaid (DHS) changes →
MAB2020052601MediumEffective May 26, 2020 · Provider BulletinMAB2023091301MediumEffective Sep 5, 2023 · Provider BulletinMAB2023083101MediumEffective Sep 5, 2023 · Provider BulletinMAB2024090901HighEffective Sep 9, 2024 · Provider BulletinBrowse every Pennsylvania Medicaid (DHS) change in the policy list

Related policy hubs

Pennsylvania Medicaid (DHS) policiesPA policy changesPediatricsCode 96150Code 96151Code 96152Code 96153Code 96154Code 96156Code 96158Code 96159Code 96164Code 96165Code 96167Code 96168Code S9470Code T1015

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account