MedicaidAdministrativeMedium impact
Winter FY2025 General Provider Updates
Maryland Medicaid·MD · Pediatrics, Family Medicine, General Practice +1 more·General Provider
Effective date
Jan 13, 2025
We identified it
Jun 20, 2026
Summary
Maryland Medicaid implemented four policy updates effective January 13, 2025: (1) a new 90-day limited enrollment period for hospitals and ambulance providers rendering emergency services without an SDAT number; (2) clarification that prescribers should use the Preferred Drug List (PDL) to reduce prior authorizations and copayments for patients; (3) authorization for primary care physicians to bill CPT 96110 for developmental and behavioral health screenings during well-child visits; and (4) clarification that emergency services do not require Medicaid enrollment to be reimbursed. Billing teams must update workflows to support the new emergency-only enrollment pathway and ensure developmental screening claims are processed correctly.
Action Required
By January 13, 2025: (1) Billing team must update claims processing to accept and process CPT 96110 for developmental and behavioral health screenings billed by primary care physicians (PCPs) during well-child visits. Set reimbursement rate at $8.86 for Maryland Medicaid Fee-for-Service. Add CPT 96110 to well-child visit encounter templates to prompt providers to bill when screening is performed; (2) Provider enrollment staff must communicate the new 90-day limited enrollment option to hospital and ambulance providers who previously rendered emergency services without full Medicaid enrollment. Direct eligible providers to enroll via ePREP platform; (3) Billing team must ensure claims for emergency services are not rejected for lack of provider enrollment status, as emergency services do not require prior enrollment. Update system rules to process emergency claims accordingly; (4) Clinical staff and providers should be educated on the Maryland Medicaid Preferred Drug List (PDL updated 12/06/2024) to encourage prescribing of PDL medications, which reduces prior authorization requirements and patient copayments ($1 vs $3). No system changes required for PDL guidance, but provider communication is recommended. Failure to bill CPT 96110 correctly will result in missed revenue for developmental screenings; claims for emergency services may be denied without proper system configuration.