MedicaidCoverageMedium impact
Maryland Medicaid Clinical Coverage Updates for the Third Quarter 2023 (July-September 2023)
Maryland Medicaid·MD · OB-GYN, Oncology, Pathology +3 more·Provider Transmittal
Effective date
Sep 1, 2023
We identified it
Jun 20, 2026
Summary
Maryland Medicaid has approved coverage for new RSV vaccines and treatments, cancer therapies, molecular pathology tests, and updated reimbursement rates for vaccines and hysteroscopy procedures effective from September 2023 through January 2024. Several new medications require prior authorization while vaccines and procedures have updated fee schedules.
Action Required
By January 1, 2024: Billing team must update Maryland Medicaid fee schedules for vaccine codes 90632, 90636, 90651, 90707, 90715, 90716, 90750 and hysteroscopy procedures 58555, 58558, 58562, 58563. Configure prior authorization requirements for HCPCS codes A9596, J9999, and 81401. Add new RSV vaccine codes 90678, 90679 and treatment codes 90380, 90381 to billing system with updated rates. Verify molecular pathology procedure 81401 requires prior auth effective September 1, 2023.