MedicaidBilling CodesMedium impact
MAB2026072801
Pennsylvania Medicaid (DHS)·PA · OB-GYN, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Aug 1, 2026
We identified it
Jul 29, 2026
Summary
Pennsylvania Medical Assistance updated the Family Planning Services Program fee schedule effective August 1, 2026, adding procedure code 87494 (gonorrhea/chlamydia detection test) with FP and QW modifiers for specific provider types and place of service combinations. Providers must update billing systems to recognize this new code and apply appropriate modifiers based on provider type and location.
Action Required
By August 1, 2026: Billing team must update billing system to recognize CPT code 87494 with FP (Family Planning) modifier and QW (CLIA waived test) modifier for the following provider types/specialties/place of service combinations: PT 09 (CRNP) POS 11/27, PT 10/100 (PA) POS 11/27, PT 28/280 (Independent Lab) POS 81, PT 31 (Physician) POS 11/27, PT 33/335 (CNM) POS 11/27, PT 01/183 (Hospital-based clinic) POS 22, and PT 08/082-083 (Clinics) POS 22/49. Update encounter forms and billing templates to include appropriate modifiers. Verify that billing software correctly routes these claims and does not apply to FQHC or RHC providers. Training should emphasize that code 87494 is effective August 1, 2026 following the 2026 HCPCS updates announced in MA Bulletin 99-26-04. Claims submitted without proper modifiers or from unauthorized provider types will be denied.