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Updates to the Medical Assistance Program Copayment Desk Reference MAB 99-17-06
Act
immediately
Effective date
Jun 26, 2017
Identified
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.
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What to do
immediately · 3 steps
01Review 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.
02Verify that proper billing indicators (VC codes, condition codes) are used for copayment exclusions including pregnancy, emergency services, and EPSDT screenings.
03Update staff training on copayment collection policies.
Codes mentioned
908329083490837908479085390846
Original notice
Updates to the Medical Assistance Program Copayment Desk Reference MAB 99-17-06
pa.gov · Always check the source before changing claims.
Related changes
See all Pennsylvania Medicaid (DHS) changes →MAB2022082601MediumEffective Aug 26, 2022 · Provider BulletinMAB2021063001MediumEffective Dec 21, 2020 · Provider Bulletin351702 Merge attachmentMediumEffective Nov 22, 2017 · Provider BulletinMAB2020092201MediumEffective Sep 22, 2020 · Provider BulletinBrowse every Pennsylvania Medicaid (DHS) change in the policy list