MedicaidReimbursementMedium impact
Updates to the Medical Assistance Program Copayment Desk Reference MAB 99-17-06
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Jun 26, 2017
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has updated their copayment desk reference with current fixed and sliding scale amounts. The policy clarifies copayment exclusions and emphasizes that providers cannot deny services for inability to pay copayments, though they can still attempt collection.
Action Required
Immediately: Review billing system settings to ensure correct copayment amounts are applied for Pennsylvania Medicaid patients - $3.00 for brand drugs, $1.00 for generic drugs and diagnostic tests, $0.50 per unit for psychotherapy services, and sliding scale amounts for other services. Verify that proper billing indicators (VC codes, condition codes) are used for copayment exclusions including pregnancy, emergency services, and EPSDT screenings. Update staff training on copayment collection policies.