MedicaidBilling CodesMedium impact
MAB2020052603
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Pediatrics, General Practice·Provider Bulletin
Effective date
May 26, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance updated billing codes for childhood nutrition and weight management services, replacing 5 old codes (96150-96154) with 7 new codes (96156, 96158, 96159, 96164, 96165, 96167, 96168) effective May 26, 2020. The new codes have specific fee schedules and are limited to MA beneficiaries under 21 years of age.
Action Required
Immediately: Billing team must stop using end-dated codes 96150-96154 for childhood nutrition services and update billing system to use new codes 96156, 96158, 96159, 96164, 96165, 96167, 96168 with correct modifiers (U5, U3, TJ) and fee amounts. Update encounter forms and ensure medical necessity is documented in patient records for all services. Only applies to Pennsylvania Medical Assistance patients under 21 years old.