MedicaidReimbursementHigh impact
MAB 01-16-33 MA Program Fee Schedule Updates for Certain Family Planning Services
Pennsylvania Medicaid (DHS)·PA · OB-GYN, Family Medicine, General Practice +1 more·Reimbursement
Effective date
Dec 1, 2016
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has significantly increased reimbursement rates for family planning services and will now pay hospitals separately for LARC devices (IUDs and implants) in addition to delivery payments. Fee increases range from 50% to over 400% for various contraceptive procedures.
Action Required
Immediately: Billing team must update fee schedules in billing system for all listed family planning procedure codes with new higher reimbursement rates. Hospitals must begin billing LARC devices separately using outpatient hospital claim format with FP modifier and place of service 22. Update encounter forms to ensure FP modifier is added to all family planning services for PA Medicaid patients.