MedicaidPrior AuthMedium impact
MAB2026040801
Pennsylvania Medicaid (DHS)·PA · Pediatrics, Physical Therapy, Occupational Therapy +1 more·Provider Bulletin
Effective date
Apr 8, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance now requires prior authorization for ALL pediatric adaptive seating equipment effective April 8, 2026. Providers must submit specific documentation including PT/OT evaluations, medical records, height/weight data, and evidence that less costly alternatives were considered before prescribing adaptive seating for children.
Action Required
Effective April 8, 2026: Providers prescribing pediatric adaptive seating equipment for Pennsylvania Medical Assistance beneficiaries must obtain prior authorization for ALL prescriptions. Update billing workflows to require PT/OT evaluations, medical records documenting functional level, current height/weight data, and documentation of trialed alternatives before submitting authorization requests. Claims submitted without proper prior authorization will be denied.