MedicaidBilling CodesMedium impact
c 276779
Pennsylvania Medicaid (DHS)·PA · OB-GYN, Family Medicine·Provider Bulletin
Effective date
Jul 2, 2018
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance updated the Family Planning Services fee schedule effective July 2, 2018, adding new HCPCS code J7296 (Kyleena LARC device), end-dating codes 55450 and 86729, and updating procedure code 85025 with new modifiers and provider type combinations for CLIA-waived testing.
Action Required
By July 2, 2018: Billing teams must update systems to bill new HCPCS code J7296 for Kyleena contraceptive devices in hospital settings, stop using end-dated codes 55450 and 86729, and add QW, FP, and 91 modifiers to code 85025 for CLIA-waived testing. Update the Family Planning Services covered services chart and ensure FP modifier is used for all family planning procedure codes. No new authorizations will be issued for end-dated codes after the effective date.