MedicaidCoverageMedium impact
Revised Medicaid Coverage of Sports Physicals, Effective August 14, 2023
Maryland Medicaid·MD · Pediatrics, Sports Medicine, Family Medicine·Provider Transmittal
Effective date
Aug 14, 2023
We identified it
Jun 20, 2026
Summary
Maryland Medicaid now covers sports physicals for students ages 6-18 at School Based Health Centers, effective August 14, 2023. FQHC-sponsored centers must use HCPCS T1015, while non-FQHC centers can use standard E/M codes 99202-99205 or 99212-99215.
Action Required
Immediately: School Based Health Centers must update billing systems to bill sports physicals with Place of Service Code 03 and primary diagnosis Z02.5. FQHC-sponsored SBHCs must use HCPCS T1015 only. Non-FQHC sponsored SBHCs should use CPT 99202-99205 for new patients or 99212-99215 for established patients. Update encounter forms to reflect these new billing requirements for Medicaid sports physicals.