MedicaidReimbursementMedium impact
d 005298
Pennsylvania Medicaid (DHS)·PA · OB-GYN, Family Medicine·Provider Bulletin
Effective date
Jul 1, 2008
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) significantly increased reimbursement fees for family planning clinic office visits, with CPT codes 99202, 99203, 99213, and 99214 rising from $20.00 to $35-54 range. The policy also updated several other procedure codes and requires the FP modifier for all family planning claims.
Action Required
Family planning clinics must ensure the informational modifier (FP) is used when submitting all family planning service claims to Pennsylvania Medical Assistance. Update billing system to reflect new fee schedule rates for office visit codes 99202 ($35.33), 99203 ($54.25), 99213 ($35.00), and 99214 ($54.42). Review and update fee schedules for all other affected procedure codes listed in the bulletin. Failure to use appropriate procedure code and modifier combinations will result in inappropriate claim payment or denial.