MedicaidPrior AuthMedium impact
Microsoft Word - PSR MAB 12 15 05.doc
Pennsylvania Medicaid (DHS)·PA · General Surgery, Gastroenterology, ENT (Ear, Nose & Throat) +5 more·Provider Bulletin
Effective date
Feb 1, 2006
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has eliminated prior authorization requirements for 25 common surgical procedures when performed in Ambulatory Surgical Centers (POS 24) or lower-level settings, effective February 1, 2006. Prior authorization is still required for these procedures when performed in inpatient settings and remains mandatory for cosmetic/elective procedures listed in the mandatory review section.
Action Required
Before February 1, 2006: Billing team must update prior authorization system to remove requirements for the 25 listed procedures when performed in Ambulatory Surgical Centers (POS 24) or lower-level settings. Continue requiring prior authorization for these same procedures when performed in inpatient settings. Update billing software to distinguish between outpatient and inpatient settings for these codes. Train staff on mandatory review procedures that still require prior authorization regardless of setting.