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Upcoming changes related to reproductive health services coverage
Effective date
Not stated in the notice
Identified
Oct 2, 2026
Summary
Pennsylvania DHS and CHIP are expanding coverage for certain reproductive health services historically covered only in limited circumstances. Some services will be funded with state dollars only, requiring separate payment and reimbursement arrangements with managed care organizations. No immediate action is required; current policies remain in effect until DHS communicates a future implementation date.
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What to do
Action · 3 steps
01Billing team must monitor communications from Geisinger Health Plan for updates on: (1) specific reproductive health services being added to coverage, (2) applicable billing codes and modifiers, (3) new billing processes for state-funded versus federally-funded services, (4) separate reimbursement arrangements with managed care organizations, and (5) any administrative requirements.
02When DHS announces the implementation date, billing team must update billing software, encounter forms, and internal procedures accordingly.
03Until then, continue using current policies for reproductive health service billing.
Original notice
Upcoming changes related to reproductive health services coverage
geisinger.org · Always check the source before changing claims.