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Microsoft Word - DME Local to National Crosswalk MAB Draft 11-17-05.doc

Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Dec 5, 2005
We identified it
Jun 20, 2026
Days to comply

Summary

Pennsylvania Medical Assistance (Medicaid) is transitioning from local procedure codes to national HCPCS codes for durable medical equipment, medical supplies, vision and hearing supplies, with new prior authorization requirements for specific codes. This affects all DME providers billing Pennsylvania Medicaid fee-for-service plans.

Action Required

Action needed
By December 5, 2005: Billing team must stop using all local Pennsylvania Medicaid codes (W, Y, Z prefixes) and replace with corresponding national HCPCS codes per the crosswalk document. Update billing system to require prior authorization for all specified E, K, L, S, and V codes listed. Configure system to use new pricing modifiers (NU, RR, RT, LT, 50, U7, U8, U9, UB, U4) as specified in fee schedule. Claims using old local codes will be denied after effective date.

Affected Billing Codes

E0144
E0445
E1035
E1060
E1223
E1224
E1228
E1231
E1800
K0009
K0014
K0108
L1200
L3060
L3201
L3202
L3203
L3204
L3206
L3207
L3215
L3216
L3217
L3219
L3221
L3222
L3224
L3225
L3230
L3250
L8190
L8200
L8210
L8500
L8501
S8999
V5160
E0424
E0439
E1250
E1270
E1298
E1390
L0100
L0110
L0976
L1810
L3140
L8195
V5242
V5243
V5248
V5249
A4206
A4207
A4208
A4209
A4213
A4215
A4221
A4222
A4335
A4353
A4362
A4365
A4402
A4421
A4554
A4580
A4606
A4617
A4618
A4627
A4628
A4629
A4927
A6208
A6501
A6503
A6504
A6505
A6506
A6509
A6511
A6512
A9900
B4164
B4168
B4172
B4176
B4178
B4180
B4184
B4186
B4189
B4193
B4197
B4199
B4216
B5000
B5100
B5200
B9998
E0241
E0315
E0602
E0710
E1340
E1399