When does this change take effect?

This change is effective Jan 3, 2011.

Pennsylvania Medicaid (DHS)Medicaid · Billing Codes · Coding · PA · Orthopedics, General Surgery, Cardiology +4 moreMedium impact

Microsoft Word - 2010 HCPCS Updates MAB _B Yakum_ 11-09-10

Q: Who is affected by this change?

This affects Pennsylvania Medicaid (DHS) Orthopedics, General Surgery, Cardiology, Radiology, OB-GYN, Ophthalmology +1 more providers in PA on Medicaid plans.

Q: Which billing codes are affected?

The following codes are affected: 14301, 14302, 21011, 21012, 21013, 21014, 21016, 21552, 21554, 21558, 21931, 21932, 21933, 21936, 22901, 22902, 22903, 22904, 22905, 23071, 23073, 23078, 24071, 24073, 24079, 25071, 25073, 25078, 26111, 26113, 26118, 27043, 27045, 27059, 27337, 27339, 27364, 27616, 27632, 27634, 28039, 28041, 28047, 29581, 31626, 32552, 32553, 32561, 32562, 33782, 33783, 33981, 33982, 33983, 36147, 36148, 37761, 43281, 43282, 43775, 45171, 45172, 46707, 49411, 51727, 51728, 51729, 57426, 63661, 63662, 63663, 63664, 64490, 64491, 64492, 64493, 64494, 64495, 75571, 75572, 75573, 75574, 75791, 78451, 78452, 78453, 78454, 83987, 84145, 84431, 86305, 86352, 86780, 86825, 86826, 87150, 87153, 87493, 88387, 88388, 92540, 92550, 92570, 93750, 95905, A4264, A4456, E0433, G0430, G0431, K0739, L8031, L8032, L8627, L8628, L8629, 20690, 36475, 36476, 36478, 36479, 37722, 49061, 61533, 92526, 93290, 93291, 93297, 93298, 93299, 99464, G0328, 01632, 14300, 23221, 23222, 24151, 24153, 26255, 26261, 27079, 29220, 36145, 36834, 45170, 46210, 46211, 46937, 46938, 51795, 63660, 64470, 64472, 64475, 64476, 75790, 78460, 78461, 78464, 78465, 78478, 78480, 82307, 86781, 90185, 90379, 92569, A4365, A6200, A6201, A6202, A6543, E1340, E2223, E2393, G0392, G0393, K0157, L0210, L0332, L1800, L1815, L1825, L1901, L2770, L3651, L3652, L3700, L3701, L3909, L3911, L6639, W9410, X1164, 11720, 58760, 66982, E0603.

Effective date

Jan 3, 2011

Identified

Jun 20, 2026

Summary

Already effective January 3, 2011: The Pennsylvania MA fee schedule adds codes from the 2010 HCPCS updates and codes added through significant program exception requests, and end-dates listed codes. Local codes W9410 and X1164 are end-dated January 2, 2011 and replaced by 99464 and 11720. Code 66982 billed with modifier SG has its MA fee increased from $776.00 to $1654.00. Prior authorization applies to listed prosthesis, durable medical equipment, and advanced radiology codes.

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What to do

Action · 7 steps

01Already effective January 3, 2011: Billing team should bill 99464 in place of local code W9410, and 11720 in place of local code X1164, in charge entry, because the local codes are end-dated January 2, 2011 and replaced January 3, 2011.

02Get prior authorization for L8031, L8032, L8627, L8628, L8629, A4264, E0603 with the NU modifier (breast pump purchase, which replaces the end-dated RR rental modifier), and 75571, 75572, 75573, 75574, 78451, 78452, 78453, 78454 under MA Bulletin 99-08-08.

03For end-dated codes that had prior authorization, submit claims with the end-dated code listed in the authorization.

04The Department will accept those claims until January 3, 2012 for previously authorized services, so check current applicability of that date before acting.

05Do not bill 58760 (fimbrioplasty), because the Department cannot pay providers for infertility therapy services.

06Bill 66982 with modifier SG at the new MA fee.

07Providers in the managed care system should send coding or billing questions to their managed care organization.

Codes mentioned

143011430221011210122101321014210162155221554215582193121932219332193622901229022290322904229052307123073230782407124073240792507125073250782611126113261182704327045270592733727339273642761627632276342803928041280472958131626325523255332561325623378233783339813398233983361473614837761432814328243775451714517246707494115172751728517295742663661636626366363664644906449164492644936449464495755717557275573755747579178451784527845378454839878414584431863058635286780868258682687150871538749388387883889254092550925709375095905A4264A4456E0433G0430G0431K0739L8031L8032L8627L8628L8629206903647536476364783647937722490616153392526932909329193297932989329999464G03280163214300232212322224151241532625526261270792922036145368344517046210462114693746938517956366064470644726447564476757907846078461784647846578478784808230786781901859037992569A4365A6200A6201A6202A6543E1340E2223E2393G0392G0393K0157L0210L0332L1800L1815L1825L1901L2770L3651L3652L3700L3701L3909L3911L6639W9410X1164117205876066982E0603

Original notice

Microsoft Word - 2010 HCPCS Updates MAB _B Yakum_ 11-09-10

pa.gov · Always check the source before changing claims.

View original ↗

MAB2024052802MediumEffective May 28, 2024 · Provider Bulletin MAB2024052801HighEffective May 28, 2024 · Provider Bulletin MAB2024090901HighEffective Sep 9, 2024 · Provider Bulletin 990804att.xlsmMediumEffective Mar 15, 2008 · Provider Bulletin Browse every Pennsylvania Medicaid (DHS) change in the policy list

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Pennsylvania Medicaid (DHS) policies PA policy changes Orthopedics General Surgery Cardiology Radiology OB-GYN Ophthalmology Pathology Code 14301 Code 14302 Code 21011 Code 21012 Code 21013 Code 21014 Code 21016 Code 21552 Code 21554 Code 21558 Code 21931 Code 21932 Code 21933 Code 21936 Code 22901 Code 22902 Code 22903 Code 22904 Code 22905 Code 23071 Code 23073 Code 23078 Code 24071 Code 24073 Code 24079 Code 25071 Code 25073 Code 25078 Code 26111 Code 26113 Code 26118 Code 27043 Code 27045 Code 27059 Code 27337 Code 27339 Code 27364 Code 27616 Code 27632 Code 27634 Code 28039 Code 28041 Code 28047 Code 29581 Code 31626 Code 32552 Code 32553 Code 32561 Code 32562 Code 33782 Code 33783 Code 33981 Code 33982 Code 33983 Code 36147 Code 36148 Code 37761 Code 43281 Code 43282 Code 43775 Code 45171 Code 45172 Code 46707 Code 49411 Code 51727 Code 51728 Code 51729 Code 57426 Code 63661 Code 63662 Code 63663 Code 63664 Code 64490 Code 64491 Code 64492 Code 64493 Code 64494 Code 64495 Code 75571 Code 75572 Code 75573 Code 75574 Code 75791 Code 78451 Code 78452 Code 78453 Code 78454 Code 83987 Code 84145 Code 84431 Code 86305 Code 86352 Code 86780 Code 86825 Code 86826 Code 87150 Code 87153 Code 87493 Code 88387 Code 88388 Code 92540 Code 92550 Code 92570 Code 93750 Code 95905 Code A4264 Code A4456 Code E0433 Code G0430 Code G0431 Code K0739 Code L8031 Code L8032 Code L8627 Code L8628 Code L8629 Code 20690 Code 36475 Code 36476 Code 36478 Code 36479 Code 37722 Code 49061 Code 61533 Code 92526 Code 93290 Code 93291 Code 93297 Code 93298 Code 93299 Code 99464 Code G0328 Code 01632 Code 14300 Code 23221 Code 23222 Code 24151 Code 24153 Code 26255 Code 26261 Code 27079 Code 29220 Code 36145 Code 36834 Code 45170 Code 46210 Code 46211 Code 46937 Code 46938 Code 51795 Code 63660 Code 64470 Code 64472 Code 64475 Code 64476 Code 75790 Code 78460 Code 78461 Code 78464 Code 78465 Code 78478 Code 78480 Code 82307 Code 86781 Code 90185 Code 90379 Code 92569 Code A4365 Code A6200 Code A6201 Code A6202 Code A6543 Code E1340 Code E2223 Code E2393 Code G0392 Code G0393 Code K0157 Code L0210 Code L0332 Code L1800 Code L1815 Code L1825 Code L1901 Code L2770 Code L3651 Code L3652 Code L3700 Code L3701 Code L3909 Code L3911 Code L6639 Code W9410 Code X1164 Code 11720 Code 58760 Code 66982 Code E0603

Microsoft Word - 2010 HCPCS Updates MAB _B Yakum_ 11-09-10

Summary

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What to do

Codes mentioned

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