MedicaidBilling CodesMedium impact
mab2025111301
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Nov 13, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is adding new procedure codes with various effective dates through January 2026, removing some codes, and implementing prior authorization requirements for durable medical equipment codes starting December 1, 2025. The policy also updates laboratory testing provider eligibility and adjusts post-operative days for certain surgical procedures.
Action Required
By November 30, 2025: Update billing system to end-date codes A9155, E0575 with NU/RR modifiers, and M0248. By December 1, 2025: Add new procedure codes including 87626, 91323, A9154, E1022-E1034, G0562-G0563, and all L-codes with laterality modifiers. Configure prior authorization requirements for all L-codes, E1032-E1034 with NU modifier, and G0562-G0563 codes. Update laboratory billing eligibility for codes 87491, 87563, 87591, 87634, and 87807. By January 1, 2026: Add codes A4295-A4297. Applies only to Pennsylvania Medicaid Fee-for-Service patients.