MedicaidPrior AuthMedium impact
MAB2026011501
Pennsylvania Medicaid (DHS)·PA · Podiatry, Orthopedics, Pediatrics +1 more·Provider Bulletin
Effective date
Jan 15, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has established new prior authorization guidelines for orthopedic shoes, boots, and shoe additions effective January 15, 2026. All prescriptions for these items now require prior authorization with specific medical documentation, and coverage is limited to beneficiaries under 21 years of age only.
Action Required
Immediately: Update billing workflows to require prior authorization for all orthopedic shoes, boots, and shoe additions for Pennsylvania Medicaid patients under 21. Ensure providers submit required documentation including relevant diagnoses, X-rays when appropriate, medical necessity documentation, physical therapy evaluations, medical records showing physical function/impairment, documentation of other devices tried, and justification for custom items. Claims without prior authorization will be denied.