MedicaidBilling CodesHigh impact
99-19-02 2019 EPSDT Periodicity Schedule MAB
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Aug 19, 2019
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) updated their fee schedule with 2019 HCPCS changes, adding 100+ new procedure codes and end-dating 40+ obsolete codes. New prior authorization requirements added for advanced radiology services (77046-77049), durable medical equipment, and prosthetic codes.
Action Required
Immediately: Billing team must update Pennsylvania Medicaid billing system to include new procedure codes (10004-V5221) and remove end-dated codes (10022-V5220). Add prior authorization requirements for radiology codes 77046-77049, DME codes E0277, E0986, E1012 (NU/RR modifiers), and prosthetic codes V5171-V5221. Stop billing end-dated codes after August 19, 2020 for previously authorized services. Update fee schedules and encounter forms to reflect new billing limitations and modifier requirements.