Who is affected by this change?

This affects Pennsylvania Medicaid (DHS) in PA on Medicaid plans.

When does this change take effect?

This change is effective May 26, 2020.

MedicaidBilling CodesHigh impact

MAB2020052601

Q: Which billing codes are affected?

The following codes are affected: 15769, 15771, 15772, 15773, 15774, 20700, 20701, 20702, 20703, 20704, 20705, 21601, 21602, 21603, 33016, 33017, 33018, 33019, 33858, 33859, 33871, 34717, 34718, 35702, 35703, 46948, 49013, 49014, 62328, 62329, 66987, 66988, 74221, 74248, 78429, 78430, 78431, 78432, 78433, 78434, 78459, 78491, 78492, 78830, 78831, 78832, 78835, 80187, 80285, 81307, 81308, 92201, 92202, 93985, 93986, 95700, 95705, 95706, 95707, 95708, 95709, 95710, 95711, 95712, 95713, 95714, 95715, 95716, 95717, 95718, 95719, 95720, 95721, 95722, 95723, 95724, 95725, 95726, 96156, 96158, 96159, 96164, 96165, 96167, 96168, 97129, 97130, 99490, D1551, D1552, D1553, D1556, D1557, D1558, D8703, D8704, G2064, G2065, G2066, 19260, 19271, 19272, 19304, 20926, 33010, 33011, 33015, 33860, 33870, 35721, 35741, 35761, 43401, 64402, 64410, 64413, 74241, 74245, 74247, 74249, 74260, 76930, 78205, 78206, 78320, 78607, 78647, 78710, 78805, 78806, 78807, 93299, 95827, 95831, 95832, 95833, 95834, 95950, 95951, 95953, 95956, 96150, 96151, 96152, 96153, 96154, 97127, D1550, D1555, G0365.

Pennsylvania Medicaid (DHS)·PA·Provider Bulletin

Effective date

May 26, 2020

We identified it

Jun 20, 2026

Days to comply

—

Summary

Pennsylvania Medical Assistance (Medicaid) is adding 130+ new HCPCS/CPT codes and end-dating 51 codes effective May 26, 2020. Advanced radiology codes (78429-78835) and orthodontic codes (D8703-D8704) require prior authorization.

Action Required

Action needed

Immediately: Update billing software to add new procedure codes and end-date obsolete codes. Obtain prior authorization before billing advanced radiology codes (78429-78835 series) and orthodontic codes (D8703, D8704). Claims with end-dated codes will be accepted until May 26, 2021 only for previously authorized services. Billing team must verify Pennsylvania Medicaid fee schedule updates online.

Affected Billing Codes

15769

15771

15772

15773

15774

20700

20701

20702

20703

20704

20705

21601

21602

21603

33016

33017

33018

33019

33858

33859

33871

34717

34718

35702

35703

46948

49013

49014

62328

62329

66987

66988

74221

74248

78429

78430

78431

78432

78433

78434

78459

78491

78492

78830

78831

78832

78835

80187

80285

81307

81308

92201

92202

93985

93986

95700

95705

95706

95707

95708

95709

95710

95711

95712

95713

95714

95715

95716

95717

95718

95719

95720

95721

95722

95723

95724

95725

95726

96156

96158

96159

96164

96165

96167

96168

97129

97130

99490

D1551

D1552

D1553

D1556

D1557

D1558

D8703

D8704

G2064

G2065

G2066

19260

19271

19272

19304

20926

33010

33011

33015

33860

33870

35721

35741

35761

43401

64402

64410

64413

74241

74245

74247

74249

74260

76930

78205

78206

78320

78607

78647

78710

78805

78806

78807

93299

95827

95831

95832

95833

95834

95950

95951

95953

95956

96150

96151

96152

96153

96154

97127

D1550

D1555

G0365

Related policy hubs

Pennsylvania Medicaid (DHS) policies PA policy changes Code 15769 Code 15771 Code 15772 Code 15773 Code 15774 Code 20700 Code 20701 Code 20702 Code 20703 Code 20704 Code 20705 Code 21601 Code 21602 Code 21603 Code 33016 Code 33017 Code 33018 Code 33019 Code 33858 Code 33859 Code 33871 Code 34717 Code 34718 Code 35702 Code 35703 Code 46948 Code 49013 Code 49014 Code 62328 Code 62329 Code 66987 Code 66988 Code 74221 Code 74248 Code 78429 Code 78430 Code 78431 Code 78432 Code 78433 Code 78434 Code 78459 Code 78491 Code 78492 Code 78830 Code 78831 Code 78832 Code 78835 Code 80187 Code 80285 Code 81307 Code 81308 Code 92201 Code 92202 Code 93985 Code 93986 Code 95700 Code 95705 Code 95706 Code 95707 Code 95708 Code 95709 Code 95710 Code 95711 Code 95712 Code 95713 Code 95714 Code 95715 Code 95716 Code 95717 Code 95718 Code 95719 Code 95720 Code 95721 Code 95722 Code 95723 Code 95724 Code 95725 Code 95726 Code 96156 Code 96158 Code 96159 Code 96164 Code 96165 Code 96167 Code 96168 Code 97129 Code 97130 Code 99490 Code D1551 Code D1552 Code D1553 Code D1556 Code D1557 Code D1558 Code D8703 Code D8704 Code G2064 Code G2065 Code G2066 Code 19260 Code 19271 Code 19272 Code 19304 Code 20926 Code 33010 Code 33011 Code 33015 Code 33860 Code 33870 Code 35721 Code 35741 Code 35761 Code 43401 Code 64402 Code 64410 Code 64413 Code 74241 Code 74245 Code 74247 Code 74249 Code 74260 Code 76930 Code 78205 Code 78206 Code 78320 Code 78607 Code 78647 Code 78710 Code 78805 Code 78806 Code 78807 Code 93299 Code 95827 Code 95831 Code 95832 Code 95833 Code 95834 Code 95950 Code 95951 Code 95953 Code 95956 Code 96150 Code 96151 Code 96152 Code 96153 Code 96154 Code 97127 Code D1550 Code D1555 Code G0365