← Back to list
MAB 01-16-33 MA Program Fee Schedule Updates for Certain Family Planning Services
Effective date
Dec 1, 2016
Identified
Jun 20, 2026
Summary
Pennsylvania Medical Assistance will pay hospitals for LARC intrauterine devices and contraceptive implants in addition to the APR-DRG payment for an obstetrical delivery under the fee-for-service delivery system. MA fees are also updated for certain family planning and family planning-related services, such as CPT 99213, which rises from $35.00 to $63.14. The fee updates and LARC payments are effective for dates of service on and after December 1, 2016.
Get alerts when payers change rules like this one
We check Pennsylvania Medicaid (DHS) and other payers every day and email you when a change matches your specialty and state.
Get Pennsylvania Medicaid (DHS) alertsPolicy Monitoring is free. No card required.
What to do
Action · 5 steps
01Already effective December 1, 2016: Hospitals submit claims for LARC intrauterine devices and contraceptive implants in an outpatient hospital claim format, using the procedure codes and the FP informational modifier listed in Attachment 1.
02Hospitals are paid for these LARC devices in addition to the APR-DRG payment for an obstetrical delivery.
03Providers rendering family planning services use the procedure codes and updated MA fee amounts in Attachment 2 for dates of service on and after December 1, 2016.
04Providers in managed care should direct fee questions to the appropriate managed care organization.
05Check the current MA Program Fee Schedule to confirm these fee amounts still apply.
Codes mentioned
J7297J7298J7300J7301J7307S4989119761198111982119831711017111469004691646924540505405654065552505642056440565015651556605566065706157065571705742157452574545745557456574605746157500575055751157800581005830058301585626443576856768578100281025850188670387086872078721087623876248762588305992019920299203992049920599212992139921499215993849938599386993949939599396
Original notice
MAB 01-16-33 MA Program Fee Schedule Updates for Certain Family Planning Services
pa.gov · Always check the source before changing claims.
Related changes
See all Pennsylvania Medicaid (DHS) changes →MAB2024052802MediumEffective May 28, 2024 · Provider BulletinMAB2023060101MediumEffective Jun 1, 2023 · Provider BulletinMAB2025021801MediumEffective Feb 18, 2025 · Provider BulletinMAB2024090902MediumEffective Jul 1, 2024 · Provider BulletinBrowse every Pennsylvania Medicaid (DHS) change in the policy list
Related policy hubs
Pennsylvania Medicaid (DHS) policiesPA policy changesOB-GYNFamily MedicineUrologyCode J7297Code J7298Code J7300Code J7301Code J7307Code S4989Code 11976Code 11981Code 11982Code 11983Code 17110Code 17111Code 46900Code 46916Code 46924Code 54050Code 54056Code 54065Code 55250Code 56420Code 56440Code 56501Code 56515Code 56605Code 56606Code 57061Code 57065Code 57170Code 57421Code 57452Code 57454Code 57455Code 57456Code 57460Code 57461Code 57500Code 57505Code 57511Code 57800Code 58100Code 58300Code 58301Code 58562Code 64435Code 76856Code 76857Code 81002Code 81025Code 85018Code 86703Code 87086Code 87207Code 87210Code 87623Code 87624Code 87625Code 88305Code 99201Code 99202Code 99203Code 99204Code 99205Code 99212Code 99213Code 99214Code 99215Code 99384Code 99385Code 99386Code 99394Code 99395Code 99396