MedicaidPrior AuthHigh impact
MAB2026020401
Pennsylvania Medicaid (DHS)·PA · Orthopedics, PM&R (Physical Medicine & Rehab), Physical Therapy +4 more·Provider Bulletin
Effective date
Feb 4, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) now requires prior authorization for all lower extremity orthoses prescriptions effective immediately. New clinical guidelines and documentation requirements have been established for different types of orthoses including pelvic/thoracic control, knee joints, fracture orthoses, and miscellaneous lower limb support devices.
Action Required
Immediately: All providers prescribing lower extremity orthoses for Pennsylvania Medicaid patients must obtain prior authorization before prescribing. Update billing workflows to require prior auth submission with specific documentation including medical diagnoses, X-ray/MRI reports when appropriate, physical therapy evaluations, range of motion assessments, and evidence of failed alternative treatments. Review the new clinical guidelines in PROMISe Provider Handbook sections 7.1.2.8 and 7.1.2.6. Claims for lower extremity orthoses without prior authorization will be denied.