MedicaidBilling CodesMedium impact
MAB2019120901
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Dec 10, 2019
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) will not separately pay for observation services when a beneficiary is directly admitted to inpatient or short procedure unit from observation. Hospitals must bill only the inpatient admission or short procedure unit procedure, not both services.
Action Required
Immediately: Billing team must update billing procedures to ensure observation services are NOT billed separately when PA Medicaid patients are directly admitted to inpatient or short procedure unit from observation. Only bill the inpatient admission or short procedure unit procedure per PA DHS billing guidelines. Review current claims to ensure compliance.