MedicaidBilling CodesHigh impact
Microsoft Word - MAB OT Local to National Code Cross Walk 11.30.05.doc
Pennsylvania Medicaid (DHS)·PA · Occupational Therapy·Provider Bulletin
Effective date
Jan 1, 2006
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is replacing local occupational therapy billing code W5300 with national CPT code 97530 effective January 1, 2006, as required by HIPAA compliance. Providers must use the national code for all occupational therapy services to MA recipients under age 21 or claims will be denied.
Action Required
By January 1, 2006: Billing team must stop using local procedure code W5300 and update billing system to use national CPT code 97530 for all occupational therapy services for Medicaid recipients under age 21. Update encounter forms and billing software with the new code. Failure to use the correct national code will result in claim denials or inappropriate payments.