[49 Pa.B. 4211]
[Saturday, August 10, 2019]
[Continued from previous Web Page] (Editor's Note: This document continues from Part II which begins at 49 Pa.B. 4211 (August 10, 2019).)
Year Code Citation(s) Subject Date Issued Bulletin
NumberCh. 1121 Prior Authorization of Early Refills Exemptions and Automated Approvals—Pharmacy Services 11/02/11 01-11-53
09-11-53
27-11-51
02-11-47
11-11-48
30-11-47
03-11-48
14-11-48
31-11-52
08-11-55
24-11-54
32-11-47
33-11-15Ch. 1150 Announcing the Federally Mandated Implementation of the National Correct Coding Initiative (NCCI) in the Pennsylvania Department of Public Welfare's Medical Assistance Program 11/10/11 99-11-10 Ch. 1150 ClaimCheck® Claims Criteria—Update 11/23/11 99-11-11 Ch. 1101
1150Medical Assistance Electronic Health Record (EHR) Incentive Program Year 2 for Eligible Professionals (EP) 12/02/11 08-11-56
09-11-54
27-11-52
31-11-53
33-11-16Ch. 1101
1150Medical Assistance Electronic Health Record (EHR) Incentive Program Year 2 for Eligible Hospitals (EH) 12/02/11 01-11-54 Ch. 1121 Prior Authorization of Anticoagulants—Pharmacy Services 12/03/11 01-11-57
09-11-57
27-11-55
33-11-19
02-11-50
11-11-51
30-11-50
03-11-51
14-11-51
31-11-56
08-11-59
24-11-57
32-11-50Ch. 1121 Prior Authorization of Erythropoiesis Stimulating Agents—Pharmacy Services 12/03/11 01-11-56
09-11-56
27-11-54
33-11-18
02-11-49
11-11-50
30-11-49
03-11-50
14-11-50
31-11-55
08-11-58
24-11-56
32-11-49Ch. 1121 Prior Authorization of Antipsychotics—Pharmacy Services 12/09/11 01-11-52
09-11-52
27-11-50
02-11-46
11-11-46
30-11-46
03-11-47
14-11-47
31-11-51
08-11-54
24-11-53
32-11-46
33-11-14Ch. 1121 Prior Authorization of Hepatitis C Agents—Pharmacy Services 12/10/11 01-11-55
09-11-55
27-11-53
33-11-17
02-11-48
11-11-49
30-11-48
03-11-49
14-11-49
31-11-54
08-11-57
24-11-55
32-11-48Ch. 1121 Medical Assistance Pharmacy Benefit Package Change 12/30/11 99-11-58
14-11-52
18-11-03
24-11-58
27-11-56
31-11-57
33-11-202012 Ch. 1121 Prior Authorization of Antidepressants, Other—Pharmacy Services 01/26/12 01-12-02
09-12-02
27-12-02
33-12-02
02-12-02
11-12-02
30-12-02
03-12-02
14-12-02
31-12-02
08-12-02
24-12-02
32-12-02Ch. 1121 Prior Authorization of Antihypertensives, Sympatholytic—Pharmacy Services 01/26/12 01-12-04
08-12-04
14-12-04
30-12-04
33-12-04
02-12-04
09-12-04
24-12-04
31-12-04
03-12-04
11-12-04
27-12-04
32-12-04Ch. 1121 Prior Authorization of Antihistamines, Minimally Sedating—Pharmacy Services 01/26/12 01-12-03
09-12-03
27-12-03
33-12-03
02-12-03
11-12-03
30-12-03
03-12-03
14-12-03
31-12-03
08-12-03
24-12-03
32-12-03Ch. 1121 Preferred Drug List (PDL) Update February 2012—Pharmacy Services 01/26/12 01-12-01
09-12-01
27-12-01
33-12-01
02-12-01
11-12-01
30-12-01
03-12-01
14-12-01
31-12-01
08-12-01
24-12-01
32-12-01Ch. 1121 Prior Authorization of Cymbalta—Pharmacy Services 01/26/12 01-12-06
09-12-06
27-12-06
33-12-06
02-12-06
11-12-06
30-12-06
03-12-06
14-12-06
31-12-06
08-12-06
24-12-06
32-12-06Ch. 1121 Prior Authorization of Bronchodilators, Beta Agonists—Pharmacy Services 01/26/12 01-12-05
09-12-05
27-12-05
33-12-05
02-12-05
11-12-05
30-12-05
03-12-05
14-12-05
31-12-05
08-12-05
24-12-05
32-12-05Ch. 1121 Prior Authorization of Emollients—Pharmacy Services 01/30/12 01-12-08
09-12-08
27-12-08
33-12-08
02-12-08
11-12-08
30-12-08
03-12-08
14-12-08
31-12-08
08-12-08
24-12-08
32-12-08Ch. 1121 Prior Authorization of Antipsychotics—Pharmacy Services 01/30/12 01-12-07
09-12-07
27-12-07
33-12-07
02-12-07
11-12-07
30-12-07
03-12-07
14-12-07
31-12-07
08-12-07
24-12-07
32-12-07Ch. 1121 Prior Authorization of Intranasal Rhinitis Agents—Pharmacy Services 02/01/12 01-12-11
09-12-11
27-12-11
33-12-11
02-12-11
11-12-11
30-12-11
03-12-11
14-12-11
31-12-11
08-12-11
24-12-11
32-12-11Ch. 1121 Prior Authorization of Enzyme Replacements, Gauchers Disease—Pharmacy Services 02/01/12 01-12-09
08-12-09
14-12-09
30-12-09
33-12-09
02-12-09
09-12-09
24-12-09
31-12-09
03-12-09
11-12-09
27-12-09
32-12-09Ch. 1121 Prior Authorization of Immunomodulators, Atopic Dermatitis—Pharmacy Services 02/01/12 01-12-10
08-12-10
14-12-10
30-12-10
33-12-10
02-12-10
09-12-10
24-12-10
31-12-10
03-12-10
11-12-10
27-12-10
32-12-10Ch. 1121 Prior Authorization of Iron, Parenteral—Pharmacy Services 02/01/12 01-12-12
08-12-12
14-12-12
30-12-12
33-12-12
02-12-12
09-12-12
24-12-12
31-12-12
03-12-12
11-12-12
27-12-12
32-12-12Ch. 1121 Prior Authorization of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)—Pharmacy Services 02/03/12 01-12-15
09-12-15
27-12-15
33-12-15
02-12-15
11-12-15
30-12-15
03-12-15
14-12-15
31-12-15
08-12-15
24-12-15
32-12-15Ch. 1121 Prior Authorization of Myalgia and Neuropathy Agents—Pharmacy Services 02/03/12 01-12-14
08-12-14
14-12-14
30-12-14
33-12-14
02-12-14
09-12-14
24-12-14
31-12-14
03-12-14
11-12-14
27-12-14
32-12-14Ch. 1121 Prior Authorization of Sedative Hypnotics—Pharmacy Services 02/06/12 01-12-19
09-12-19
27-12-19
33-12-19
02-12-19
11-12-19
30-12-19
03-12-19
14-12-19
31-12-19
08-12-19
24-12-19
32-12-19Ch. 1121 Prior Authorization of Botulinum Toxins—Pharmacy Services 02/06/12 01-12-13
09-12-13
27-12-13
33-12-13
02-12-13
11-12-13
30-12-13
03-12-13
14-12-13
31-12-13
08-12-13
24-12-13
32-12-13Ch. 1121 Prior Authorization of Stimulants and Related Agents—Pharmacy Services 02/06/12 01-12-21
09-12-21
27-12-21
33-12-21
02-12-21
11-12-21
30-12-21
03-12-21
14-12-21
31-12-21
08-12-21
24-12-21
32-12-21Ch. 1121 Prior Authorization of Otic Anti-Infectives and Anesthetics—Pharmacy Services 02/13/12 01-12-18
08-12-18
14-12-18
30-12-18
33-12-18
02-12-18
09-12-18
24-12-18
31-12-18
03-12-18
11-12-18
27-12-18
32-12-18Ch. 1121 Prior Authorization of Ophthalmic Antibiotic-Steroid Combinations—Pharmacy Services 02/13/12 01-12-17
08-12-17
14-12-17
30-12-17
33-12-17
02-12-17
09-12-17
24-12-17
31-12-17
03-12-17
11-12-17
27-12-17
02-12-17Ch. 1121 Prior Authorization of Smoking Cessation Products—Pharmacy Services 02/14/12 01-12-20
09-12-20
27-12-20
03-12-20
02-12-20
11-12-20
30-12-20
03-12-20
14-12-20
31-12-20
08-12-20
24-12-20
32-12-20Ch. 1128 Processing of Medicare Renal Dialysis Services Crossover Claims for Procedure Code 90999 02/21/12 30-12-22 Ch. 1101
1150Correction to Medical Assistance Electronic Health Record (EHR) Incentive Program Year 2 for Eligible Professionals (EP) 03/08/12 08-12-22
09-12-24
27-12-22
31-12-22
33-12-22Ch. 1121 Prior Authorization of Myalgia and Neuropathy Agents—Pharmacy Services 03/18/12 01-12-22
09-12-23
27-12-23
33-12-23
02-12-22
11-12-22
30-12-23
03-12-22
14-12-22
31-12-23
08-12-23
24-12-22
32-12-22Ch. 1121 Prior Authorization of Antibiotics, Topical—Pharmacy Services 03/18/12 01-12-24
09-12-25
27-12-24
33-12-25
02-12-23
11-12-23
30-12-24
03-12-23
14-12-23
31-12-25
08-12-25
24-12-23
32-12-23Ch. 1123 Removal of NU Pricing Modifier from Procedure Codes for Oxygen Contents 03/20/12 24-12-24
25-12-01Ch. 1121 Prior Authorization of Oncology Agents, Oral—Pharmacy Services 04/02/12 01-12-16
09-12-16
27-12-16
33-12-16
02-12-16
11-12-16
30-12-16
03-12-16
14-12-16
31-12-16
08-12-16
24-12-16
32-12-16— Provider Electronic Solutions (PES) Software v3.59 replaces v3.58 04/06/12 99-12-01 Ch. 1101
Ch. 1150
Ch. 1241Updates to the Medical Assistance Program Fee Schedule for the Administration of Prevnar 13® Vaccine 04/06/12 01-12-25
08-12-26
09-12-26
31-12-26
33-12-26Ch. 1101 Updates to Medical Assistance Copayment Policy 04/16/12 99-12-03 Ch. 1121 Changes to the Drug Cost Component of Payment for Brand Name and Generic Drugs—Pharmacy Services 05/01/12 01-12-28
09-12-29
27-12-26
33-12-28
02-12-25
11-12-25
30-12-26
03-12-25
14-12-25
31-12-29
08-12-28
24-12-26
32-12-25Ch. 1121 Changes to the Dispensing Fee Component of Payment for Brand Name and Generic Drugs—Pharmacy Services 05/01/12 01-12-27
09-12-28
27-12-25
33-12-27
02-12-24
11-12-24
30-12-25
03-12-24
14-12-24
31-12-24
08-12-27
24-12-25
32-12-24Ch. 1149 Revision of Online Training Module for the Application of Topical Fluoride Varnish 05/01/12 09-12-27
31-12-27Ch. 1163 Newborn Payment Policy for Acute Care General Hospitals 05/04/12 01-12-26 — Specialty Pharmacy Drug Program—Updated List of Covered Drugs—Pharmacy Services 05/11/12 99-12-04 — Electronic Forms 05/11/12 99-12-02 Ch. 1121 Prior Authorization of Makena—Pharmacy Services 05/11/12 01-12-29
02-12-26
03-12-26
08-12-29
09-12-30
11-12-26
14-12-26
24-12-27
27-12-27
30-12-27
31-12-30
32-12-26
33-12-29Ch. 1150 Consultations Performed Using Telemedicine 05/23/12 09-12-31
31-12-31
33-12-30Ch. 1229 HealthChoices Physical Health Managed Care Expansion 05/25/12 99-12-05 — Provider Preventable Conditions 06/15/12 01-12-30
03-12-27
09-12-32
18-12-01
31-12-32
33-12-31
02-12-27
08-12-30
14-12-27
27-12-28
32-12-27
47-12-01— FQHC Change in Scope of Service 06/20/12 08-12-31 Ch. 1150 2012 HCPCS Updates and Other Procedure Code Changes 06/25/12 99-12-06 Ch. 1121 Prior Authorization of Incretin Mimetic/Enhancers Hypoglycemics—Pharmacy Services 07/11/12 01-12-32
09-12-34
27-12-30
33-12-33
02-12-29
11-12-28
30-12-29
03-12-29
14-12-29
31-12-34
08-12-33
24-12-29
32-12-29Ch. 1121 Preferred Drug List (PDL) Update August 2012—Pharmacy Services 07/12/12 01-12-33
09-12-35
27-12-31
33-12-34
02-12-30
11-12-29
30-12-37
03-12-30
14-12-30
31-12-35
08-12-34
24-12-30
32-12-30Ch. 1121 Prior Authorization of Opiate Dependence Treatments—Pharmacy Services 07/13/12 01-12-36
08-12-36
14-12-31
30-12-31
33-12-35
02-12-31
09-12-37
24-12-32
31-12-37
03-12-31
11-12-30
27-12-33
32-12-31Ch. 1121 Prior Authorization of Platelet Aggregation Inhibitors—Pharmacy Services 08/03/12 01-12-45
09-12-43
27-12-39
33-12-41
02-12-37
11-12-36
30-12-37
03-12-37
14-12-37
31-12-43
08-12-42
24-12-38
32-12-37Ch. 1121 Prior Authorization of Pituitary Suppressive Agents, LHRH—Pharmacy Services 08/03/12 01-12-44
09-12-42
27-12-38
33-12-40
02-12-36
11-12-35
30-12-36
03-12-36
14-12-36
31-12-42
08-12-41
24-12-37
32-12-36Ch. 1121 Prior Authorization of Benign Prostatic Hyperplasia (BPH) Treatments—Pharmacy Services 08/03/12 01-12-41
09-12-40
27-12-36
33-12-38
02-12-34
11-12-33
30-12-34
03-12-34
14-12-34
31-12-40
08-12-39
24-12-35
32-12-34Ch. 1121 Prior Authorization of Erythropoiesis Stimulating Proteins—Pharmacy Services 08/03/12 01-12-42
09-12-41
27-12-37
33-12-39
02-12-35
11-12-34
30-12-35
03-12-35
14-12-35
31-12-41
08-12-40
24-12-36
32-12-35Ch. 1121 Prior Authorization of Antibiotics, GI—Pharmacy Services 08/03/12 01-12-39
09-12-38
27-12-34
33-12-36
02-12-32
11-12-31
30-12-32
03-12-32
14-12-32
31-12-38
08-12-37
24-12-33
32-12-32Ch. 1121 Prior Authorization of Anticoagulants—Pharmacy Services 08/03/12 01-12-40
09-12-39
27-12-35
33-12-37
02-12-33
11-12-32
30-12-33
03-12-33
14-12-33
31-12-39
08-12-38
24-12-34
32-12-33Ch. 1121 Prior Authorization of Lipotropics, Statins—Pharmacy Services 08/03/12 01-12-46
09-12-44
27-12-40
33-12-42
02-12-38
11-12-37
30-12-38
03-12-38
14-12-37
31-12-44
08-12-43
24-12-39
32-12-38Ch. 1121 Prior Authorization of Growth Factors—Pharmacy Services 08/07/12 01-12-31
08-12-32
14-12-28
30-12-28
33-12-32
02-12-28
09-12-33
24-12-28
31-12-33
03-12-28
11-12-27
27-12-29
32-12-28Ch. 1229 HealthChoices Physical Health Managed Care New West Zone Expansion 08/08/12 99-12-08 Ch. 1101
Ch. 1150Medical Assistance Program Fee Schedule Revisions 08/31/12 99-12-10 Ch. 1150 Information Regarding Peritoneal Dialysis Treatment 09/13/12 01-12-50
30-12-43
31-12-49Ch. 1101
Ch. 1150Medical Assistance Program Fee Schedule Changes for Renal Dialysis Services 09/13/12 30-12-39
13-12-45Ch. 1121 Prior Authorization of Hepatitis C Agents—Pharmacy Services 09/13/12 01-12-49
09-12-47
27-12-43
33-12-45
02-12-41
11-12-40
30-12-42
03-12-41
14-12-41
31-12-48
08-12-46
24-12-42
32-12-41Ch. 1121 Prior Authorization of Cytokine and CAM Antagonists—Pharmacy Services 09/13/12 01-12-48
09-12-46
27-12-42
33-12-44
02-12-40
11-12-39
30-12-41
03-12-40
14-12-40
31-12-47
08-12-45
24-12-41
32-12-40Ch. 1121 Prior Authorization of Bronchodilators, Anticholinergic—Pharmacy Services 09/13/12 01-12-47
09-12-45
27-12-41
33-12-43
02-12-39
11-12-38
30-12-40
03-12-39
14-12-39
31-12-46
08-12-44
24-12-40
32-12-39Ch. 1150 New Procedure Codes for Tobacco Cessation Counseling Services 10/03/12 99-12-09 Ch. 1101 Delaying Alternative Cost Sharing for Families of Children with Disabilities with Incomes Over 200 % of the Federal Poverty Income Guidelines 10/15/12 99-12-15 Ch. 1121 Prior Authorization of Botulinum Toxins—Pharmacy Services 10/22/12 01-12-53
09-12-50
27-12-46
33-12-48
02-12-44
11-12-43
30-12-46
03-12-44
14-12-44
31-12-52
08-12-49
24-12-45
32-12-44Ch. 1121 Prior Authorization of Angiotensin Modulator Combinations—Pharmacy Services 10/22/012 01-12-52
02-12-43
03-12-43
08-12-48
09-12-49
11-12-42
14-12-43
24-12-44
27-12-45
30-12-45
31-12-51
32-12-43
33-12-47Ch. 1150 Federally Mandated Implementation: Updates to National Correct Coding Initiative (NCCI) 10/26/12 99-12-12 Ch. 1121 Prior Authorization of Angiotensin Modulators—Pharmacy Services 10/30/12 01-12-54
08-12-50
14-12-45
30-12-47
33-12-49
02-12-45
09-12-51
24-12-46
31-12-53
03-12-45
11-12-44
27-12-47
32-12-45Ch. 1121 Prior Authorization of Multiple Sclerosis Agents—Pharmacy Services 10/30/12 01-12-56
08-12-52
14-12-47
30-12-49
33-12-51
02-12-47
09-12-53
24-12-48
31-12-55
03-12-47
11-12-46
27-12-49
32-12-47Ch. 1121 Prior Authorization of Tysabri—Pharmacy Services 10/30/12 01-12-57
08-12-53
14-12-48
30-12-50
33-12-52
02-12-48
09-12-54
24-12-49
31-12-56
03-12-48
11-12-47
27-12-50
32-12-48Ch. 1121 Prior Authorization of Incretin Mimetic/Enhancer Hypoglycemics—Pharmacy Services 10/30/12 01-12-55
08-12-51
14-12-46
30-12-48
33-12-50
02-12-46
09-12-52
24-12-47
31-12-54
03-12-46
11-12-45
27-12-48
32-12-46Ch.1123 Prior Authorization Requirements for the Rental of Medical Appliances and Durable Medical Equipment 12/10/12 24-12-55
25-12-02Ch. 1101
Ch. 1150Medical Assistance Program Fee Schedule Revisions 12/10/12 99-12-13 Ch. 1101
Ch. 1150
Ch. 1149Addition to the Medical Assistance Program Fee Schedule for Administration of Flu Vaccine for Intradermal Use: Fluzone Intradermal® 12/13/12 01-12-64
08-12-59
09-12-60
31-12-62
33-12-58Ch. 1150 NPI Requirements on All Claim Submission Media 12/19/12 99-12-14 Ch. 1121 Anticoagulants—New Quantity Limit for Low Molecular Weight Heparins and Arixtra (Fondaparinux)—Pharmacy Services 12/21/12 01-12-63
09-12-59
27-12-55
33-12-57
02-12-53
11-12-52
30-12-55
03-12-53
14-12-53
31-12-61
08-12-58
24-12-54
32-12-53Ch. 1121 Prior Authorization of Kalydeco—Pharmacy 12/21/12 01-12-60
09-12-56
27-12-52
33-12-54
02-12-50
11-12-49
30-12-52
03-12-50
14-12-50
31-12-58
08-12-55
24-12-51
32-12-50Ch. 1121 Prior Authorization of Hypoglycemics, TZDs—Pharmacy Services 12/21/12 01-12-61
09-12-57
27-12-53
33-12-55
02-12-51
11-12-50
30-12-53
03-12-51
14-12-51
31-12-59
08-12-56
24-12-52
32-12-51Ch. 1121 Prior Authorization of Antipsychotics—Pharmacy Services 12/21/12 01-12-62
09-12-58
27-12-54
33-12-56
02-12-52
11-12-51
30-12-54
03-12-52
14-12-52
31-12-60
08-12-57
24-12-53
32-12-52Ch. 1121 Prior Authorization of Korlym—Pharmacy Services 12/21/12 01-12-59
09-12-55
27-12-51
33-12-53
02-12-49
11-12-48
30-12-51
03-12-49
14-12-49
31-12-57
08-12-54
24-12-50
32-12-49Ch. 1150 Clinical Laboratory Improvement Amendments Requirements 12/28/12 01-12-67
08-12-62
09-12-63
28-12-01
31-13-65
33-13-612013 Ch. 1121 Prior Authorization of Antipsoriatics Topical—Pharmacy Services 01/07/13 01-13-01
09-13-01
27-13-01
33-13-01
02-13-01
11-13-01
30-13-01
03-13-01
14-13-01
31-13-01
08-13-01
24-13-01
32-13-01Ch. 1121 Prior Authorization of Antipsychotics—Pharmacy Services 01/07/13 01-13-02
09-13-02
27-13-02
33-13-02
02-13-02
11-13-02
30-13-02
03-13-02
14-13-02
31-13-02
08-13-02
24-13-02
32-13-02Ch. 1121 Prior Authorization of Diabetic Strips—Pharmacy Services 01/07/13 01-13-03
09-13-03
27-13-03
33-13-03
02-13-03
11-13-03
30-13-03
03-13-03
14-13-03
31-13-03
08-13-03
24-13-03
32-13-03Ch. 1121 Prior Authorization of Glucocorticoids Oral—Pharmacy Services 01/07/13 01-13-04
09-13-04
27-13-04
33-13-04
02-13-04
11-13-04
30-13-04
03-13-04
14-13-04
31-13-04
08-13-04
24-13-04
32-13-04Ch. 1121 Prior Authorization of Leukotriene Modifiers—Pharmacy Services 01/07/13 01-13-05
09-13-05
27-13-05
33-13-05
02-13-05
11-13-05
30-13-05
03-13-05
14-13-05
31-13-05
08-13-05
24-13-05
32-13-05Ch. 1121 Prior Authorization of Neuropathic Pain Agents (Formerly Myalgia and Neuropathy Agents)—Pharmacy Services 01/07/13 01-13-06
09-13-06
27-13-06
33-13-06
02-13-06
11-13-06
30-13-06
03-13-06
14-13-06
31-13-06
08-13-06
24-13-06
32-13-06Ch. 1121 Prior Authorization of Oncology Agents Breast Cancer—Pharmacy Services 01/07/13 01-13-07
08-13-07
14-13-07
32-13-07
02-13-07
09-13-07
24-13-07
30-13-07
03-13-07
11-13-07
27-13-07
31-13-07
33-13-07Ch. 1121 Prior Authorization of Smoking Cessation Products—Pharmacy Services 01/07/13 01-13-08
09-13-08
27-13-08
33-13-08
02-13-08
11-13-08
30-13-08
03-13-08
14-13-08
31-13-08
08-13-08
24-13-08
32-13-08Ch. 1121 Prior Authorization of Diabetic Meters—Pharmacy Services 01/07/13 01-13-09
09-13-09
27-13-09
33-13-09
02-13-09
11-13-09
30-13-09
03-13-09
14-13-09
31-13-09
08-13-09
24-13-09
32-13-09Ch. 1229 HealthChoices Physical Health Managed Care New East Zone Expansion 01/18/13 99-13-02 Ch. 1121 Preferred Drug List (PDL) Update January 15, 2013—Pharmacy Services 01/22/13 01-13-11
09-13-11
27-13-11
33-13-11
02-13-10
11-13-10
30-13-10
03-13-10
14-13-10
31-13-12
08-13-11
24-13-11
32-13-10Ch. 1150 Medical Assistance Program Fee Increase for Select Primary Care Services and Physician Attestation Form 01/22/13 31-13-11 Ch. 1121 Prior Authorization of Cytokine and CAM Antagonists—Pharmacy Services 01/25/13 01-13-12
08-13-12
14-13-11
30-13-11
33-13-12
02-13-11
09-13-12
24-13-12
31-13-13
03-13-11
11-13-11
27-13-12
32-13-11Ch. 1150 Medical Assistance Program Fee Increase for Select Primary Care Services and Physician Attestation Form 01/22/13 31-13-11 Ch. 1101
Ch. 1150Medical Assistance Electronic Health Record (EHR) Incentive Program Year 2013 for Eligible Professionals (EP) 02/01/13 08-13-10
09-13-10
27-13-10
31-13-10
33-13-10Ch. 1101
Ch. 1150Medical Assistance Electronic Health Record (EHR) Incentive Program Year 2013 for Eligible Hospitals (EH) 02/01/13 01-13-10 Ch. 1101 Updated Procedures for Submitting the Deficit Reduction Act of 2005 Attestation Form 02/14/13 99-13-04 Ch. 1229 Continued Existence of the Fee-For-Service Delivery System in HealthChoices Zones and Enrollment of Breast and Cervical Cancer Prevention and Treatment (BCCPT) Recipients in HealthChoices 02/22/13 99-13-05 Ch. 1121 Prior Authorization of Analgesics Narcotic Short Acting—Pharmacy Services 03/29/13 01-13-16
08-13-16
14-13-15
30-13-15
33-13-17
02-13-15
09-13-17
24-13-16
31-13-18
03-13-15
11-13-15
27-13-16
32-13-15Ch. 1121 Prior Authorization of Bladder Relaxant Preparations—Pharmacy Services 03/29/13 01-13-14
09-13-15
27-13-14
33-13-15
02-13-13
11-13-13
30-13-13
03-13-13
14-13-13
31-13-16
08-13-14
24-13-14
32-13-13Ch. 1121 Prior Authorization of Bronchodilators Beta Agonists Short Acting Agents—Pharmacy Services 03/29/13 01-13-17
08-13-17
14-13-16
30-13-16
33-13-18
02-13-16
09-13-18
24-13-17
31-13-19
03-13-16
11-13-16
27-13-17
32-13-16Ch. 1121 Prior Authorization of Antipsychotics—Pharmacy Services 03/29/13 01-13-13
08-13-13
14-13-12
30-13-12
33-13-14
02-13-12
09-13-14
24-13-13
31-13-15
03-13-12
11-13-12
27-13-13
32-13-12Ch. 1121 Prior Authorization of Chronic Obstructive Pulmonary Disease (COPD) Agents—Pharmacy Services 03/29/13 01-13-15
09-13-16
27-13-15
33-13-16
02-13-14
11-13-14
30-13-14
03-13-14
14-13-14
31-13-17
08-13-15
24-13-15
32-13-14Ch. 1101
Ch. 1150Medical Assistance Program Fee Schedule Revisions for Procedure Code K0606 04/01/13 24-13-10
25-13-01Ch. 1101
Ch. 1150Medical Assistance Program Fee Schedule Revisions 04/15/13 99-13-03 Ch. 1121 Medical Assistance Pharmacy Benefit Package Update 04/22/13 99-13-20
14-13-17
18-13-01
24-13-18
17-13-18
31-13-21
33-13-20Ch. 1121 Prior Authorization of Anticoagulants—Pharmacy Services 5/3/13 01-13-19
09-13-21
27-13-19
33-13-21
02-13-17
11-13-17
30-13-17
03-13-17
14-13-18
31-13-22
08-13-19
24-13-19
32-13-17Ch. 1101 Revised Physician Attestation Form for Primary Care Services 05/03/13 31-13-32 Ch. 1121 Prior Authorization of Pulmonary Arterial Hypertension (PAH) Agents Oral and Inhaled—Pharmacy Services 05/03/13 01-13-23
09-13-25
27-13-23
33-13-25
02-13-21
11-13-21
30-13-21
03-13-21
14-13-22
31-13-26
08-13-23
24-13-23
32-13-21Ch. 1121 Prior Authorization of Lyrica (pregabalin) Neuropathic Pain Agents and Oral Anticonvulsants—Pharmacy Services 05/03/13 01-13-25
09-13-27
27-13-25
33-13-27
02-13-23
11-13-23
30-13-23
03-13-23
14-13-24
31-13-28
08-13-25
24-13-25
32-13-23Ch. 1121 Prior Authorization of Multiple Sclerosis Agents—Pharmacy Services 05/03/13 01-13-20
09-13-22
27-13-20
33-13-22
02-13-18
11-13-18
30-13-18
03-13-18
14-13-19
31-13-23
08-13-20
24-13-20
32-13-18Ch. 1121 Prior Authorization of Botulinum Toxins (Type A and Type B)—Pharmacy Services 05/03/13 01-13-21
09-13-23
27-13-21
33-13-23
02-13-19
11-13-19
30-13-19
03-13-19
14-13-20
31-13-24
08-13-21
24-13-21
32-13-19Ch. 1121 Prior Authorization of Benzodiazepines; Analgesics Narcotic Long Acting; and Analgesics Narcotic Short Acting—Pharmacy Services 05/03/13 01-13-26
09-13-28
27-13-26
33-13-28
02-13-24
11-13-24
30-13-24
03-13-24
14-13-25
31-13-29
08-13-26
24-13-26
32-13-24Ch. 1121 Medicare Part D Coverage of Barbiturates and Benzodiazepines—Pharmacy Services 05/03/13 01-13-28
08-13-28
14-13-27
30-13-26
33-13-30
02-13-26
09-13-30
24-13-28
31-13-31
03-13-26
11-13-26
27-13-28
32-13-26Ch. 1121 Prior Authorization of Cytokine and CAM Antagonists—Pharmacy Services 05/03/13 01-13-27
09-13-29
27-13-27
33-13-29
02-13-25
11-13-25
30-13-25
03-13-25
14-13-26
31-13-30
08-13-27
24-13-27
32-13-25Ch. 1121 340B Drug Pricing Program Provider Requirements and Billing Instructions—Pharmacy Services 05/16/13 99-13-08 Ch. 1101 Application of InvestiClaimTM Analytics to Select Claims 05/17/13 99-13-09 Ch. 1150 Implementation of the Medical Assistance Program's Physician Fee Increases for Select Primary Care Services 05/23/13 31-13-34 Ch. 1150 Addition to the Medical Assistance Program Fee Schedule for Administration of Flu Vaccine Derived from Cell Cultures: Flucelvax 05/25/13 01-13-18
08-13-18
09-13-19
31-13-20
33-13-19Ch. 1121 Prior Authorization of Androgenic Agents—Pharmacy Services 05/31/13 01-13-22
02-13-20
03-13-20
08-13-22
09-13-24
11-13-20
14-13-21
24-13-22
27-13-22
30-13-20
31-13-25
32-13-20
33-13-24Ch. 1121 Prior Authorization of H.P. Acthar Gel—Pharmacy Services 05/31/13 01-13-24
02-13-22
03-13-22
08-13-24
09-13-26
11-13-22
14-13-23
24-13-24
27-13-24
30-13-22
31-13-27
32-13-22
33-13-26Ch. 1150 2013 HCPCS Updates and Other Procedure Code Changes 06/24/13 99-13-07 Ch. 1121 Prior Authorization of Anticoagulants—Pharmacy Services 07/02/13 01-13-38
02-13-34
03-13-34
08-13-36
09-13-38
11-13-34
14-13-35
24-13-36
27-13-36
30-13-34
31-13-42
32-13-34
33-13-38Ch. 1121 Prior Authorization of Antiparasitics Topical—Pharmacy Services 07/02/13 01-13-37
02-13-33
03-13-33
08-13-35
09-13-37
11-13-33
14-13-34
24-13-35
27-13-35
30-13-33
31-13-41
32-13-33
33-13-37Ch. 1121 Prior Authorization of Multiple Sclerosis Agents—Pharmacy Services 07/02/13 01-13-39
02-13-35
03-13-35
08-13-37
09-13-39
11-13-35
14-13-36
24-13-37
27-13-37
30-13-35
31-13-43
32-13-35
33-13-39Ch. 1150 Hospital Payment Arrangements 1 and 2 for Emergency Room Services 07/02/13 01-13-29
31-13-33Ch. 1121 Prior Authorization of Vasodilators Coronary—Pharmacy Services 07/02/13 01-13-36
02-13-32
03-13-32
08-13-34
09-13-36
11-13-32
14-13-33
24-13-34
27-13-34
30-13-32
31-13-40
32-13-32
33-13-36Ch. 1121 Prior Authorization of Incretin Mimetic/Enhancer Hypoglycemics—Pharmacy Services 07/02/13 01-13-34
02-13-30
03-13-30
08-13-32
09-13-34
11-13-30
14-13-31
24-13-32
27-13-32
30-13-30
31-13-38
32-13-30
33-13-34Ch. 1121 Prior Authorization of H. Pylori Treatments—Pharmacy Services 07/02/13 01-13-32
02-13-28
03-13-28
08-13-30
09-13-32
11-13-28
14-13-29
24-13-30
27-13-30
30-13-28
31-13-36
32-13-28
33-13-32Ch. 1121 Preferred Drug List (PDL) Update July 24, 2013—Pharmacy Services 07/07/13 01-13-31
09-13-31
27-13-29
33-13-31
02-13-27
11-13-27
30-13-27
03-13-27
14-13-28
31-13-35
08-13-29
24-13-29
32-13-27Ch. 1121 Prior Authorization of Colony Stimulating Factors—Pharmacy Services 07/13/13 01-13-33
09-13-33
27-13-31
33-13-33
02-13-29
11-13-29
30-13-29
03-13-29
14-13-30
31-13-37
08-13-31
24-13-31
32-13-29Ch. 1121 Prior Authorization of Irritable Bowel Syndrome Agents—Pharmacy Services 07/13/13 01-13-35
09-13-35
27-13-33
33-13-35
02-13-31
11-13-31
30-13-31
03-13-31
14-13-32
31-13-39
08-13-33
24-13-33
32-13-31Ch. 1121 Prior Authorization of Acne Agents Oral—Doxycycline—Pharmacy Services 07/22/13 01-13-40
08-13-38
14-13-37
30-13-36
33-13-40
02-13-36
09-13-40
24-13-38
31-13-44
03-13-36
11-13-36
27-13-38
32-13-36Ch. 1127
Ch. 1150Changes to the Payment Structure for Birth Center Services 08/29/13 09-13-13
31-13-14
33-13-13
47-13-01Ch. 1101 Medical Assistance Electronic Health Record (EHR) Incentive Program Year 2014 for Eligible Hospitals (EH) 09/20/13 01-13-41 Ch. 1101 Implementation of ADA Claim Form—Version 2012 and Elimination of ADA Claim Form—Version 2006 09/20/13 17-13-01
19-13-01
20-13-01
27-13-39
31-13-45Ch. 1101
Ch. 1149
Ch. 1129Correction to the Procedures for Reporting of Other Provider Preventable Conditions (OPPCs) for Federally Qualified Health Centers Rural Health Clinics and Dentists 10/02/13 08-13-39
27-13-41Ch. 1101 Application of InvestiClaimTM Analytics to Select Claims—Update 10/04/13 99-13-12 Ch. 1121 Prior Authorization of Anticoagulants—Pharmacy Services 11/04/13 01-13-45
09-13-45
27-13-45
33-13-44
02-13-40
11-13-40
30-13-40
03-13-40
14-13-41
31-13-50
08-13-43
24-13-42
32-13-40Ch. 1121 Prior Authorization of Angiotensin Modulators—Pharmacy Services 11/04/13 01-13-44
09-13-44
27-13-44
33-13-43
02-13-39
11-13-39
30-13-39
03-13-39
14-13-40
31-13-49
08-13-42
24-13-41
32-13-39Ch. 1121 Prior Authorization of Benign Prostatic Hyperplasia (BPH) Treatment—Pharmacy Services 11/04/13 01-13-46
09-13-46
27-13-46
33-13-45
02-13-41
11-13-41
30-13-41
03-13-41
14-13-42
31-13-51
08-13-44
24-13-43
32-13-41Ch. 1121 Prior Authorization of HIV/AIDS Medications—Pharmacy Services 11/04/13 01-13-47
09-13-47
27-13-47
33-13-46
02-13-42
11-13-42
30-13-42
03-13-42
14-13-43
31-13-52
08-13-45
24-13-44
32-13-42Ch. 1121 Prior Authorization of Alzheimer's Agents—Pharmacy Services 11/04/13 01-13-42
09-13-42
27-13-42
33-13-41
02-13-37
11-13-37
30-13-37
03-13-37
14-13-38
31-13-47
08-13-40
24-13-39
32-13-37Ch. 1121 Prior Authorization of Leukotriene Modifiers—Pharmacy Services 11/04/13 01-13-48
09-13-48
27-13-48
33-13-47
02-13-43
11-13-43
30-13-43
03-13-43
14-13-44
31-13-53
08-13-46
24-13-45
32-13-43Ch. 1121 Prior Authorization of Angiotensin Modulator Combinations—Pharmacy Services 11/04/13 01-13-43
09-13-43
27-13-43
33-13-42
02-13-38
11-13-38
30-13-38
03-13-38
14-13-39
31-13-48
08-13-41
24-13-40
32-13-38Ch. 1121 Prior Authorization of Antipsychotics—Pharmacy Services 11/22/13 01-13-52
09-13-50
27-13-49
33-13-49
02-13-44
11-13-44
30-13-44
03-13-44
14-13-45
31-13-57
08-13-49
24-13-46
32-13-44Ch. 1121 Prior Authorization of Analgesics Narcotic Long Acting
Analgesics Narcotic Short Acting and Cough and Cold Medications—Pharmacy Services11/22/13 01-13-55
09-13-53
27-13-52
33-13-52
02-13-47
11-13-47
30-13-47
03-13-47
14-13-48
31-13-60
08-13-52
24-13-49
32-13-47Ch. 1121 Prior Authorization of Vecamyl (mecamylamine)—Pharmacy Services 11/22/13 01-13-54
09-13-52
27-13-51
33-13-51
02-13-46
11-13-46
30-13-46
03-13-46
14-13-47
31-13-59
08-13-51
24-13-48
32-13-46Ch. 1121 Prior Authorization of Lipotropics Other—Pharmacy Services 11/22/13 01-13-53
09-13-51
27-13-50
33-13-50
02-13-45
11-13-45
30-13-45
03-13-45
14-13-46
31-13-58
08-13-50
24-13-47
32-13-45Ch. 1101 CAQH CORE Federal Mandate: Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) 11/22/13 99-13-14 Ch. 1101 Presumptive Eligibility as Determined by Hospitals 12/06/13 01-13-56 Ch. 1121 Preferred Drug List (PDL) Update January 22, 2014—Pharmacy Services 12/18/13 01-13-57
02-13-48
03-13-48
08-13-53
09-13-54
11-13-48
14-13-49
24-13-50
27-13-53
30-13-48
31-13-61
32-13-48
33-13-53Ch. 1150 Medical Assistance Program Fee Schedule Revisions 12/27/13 99-13-13 2014 Ch. 1150 Additions to the Medical Assistance Program Fee Schedule for Administration of Quadrivalent Flu Vaccine 08-14-02 01/07/14 01-14-03
09-14-01
31-14-02
33-14-01Ch. 1101 Changes to MA 112 Newborn Eligibility Form 01/10/14 01-14-02
47-14-01Ch. 1101 Implementation of the CMS-1500 Health Insurance Claim Form (version 02-12) 01/10/14 99-14-03 Ch. 1121 Prior Authorization of Antipsychotics—Pharmacy Services 01/20/14 01-14-05
09-14-03
27-14-02
33-14-03
02-14-02
11-14-02
30-14-02
03-14-02
14-14-02
31-14-04
08-14-04
24-14-02
32-14-02Ch. 1121 Prior Authorization of Antipsoriatics Oral—Pharmacy Services 01/20/14 01-14-04
08-14-03
14-14-01
30-14-01
33-14-02
02-14-01
09-14-02
24-14-01
31-14-03
03-14-01
11-14-01
27-14-01
32-14-01Ch. 1121 Prior Authorization of Anxiolytics—Pharmacy Services 02/03/14 01-14-06
02-14-03
03-14-03
08-14-05
09-14-04
11-14-03
14-14-03
24-14-03
27-14-03
30-14-03
31-14-05
32-14-03
33-14-04Ch. 1121 Prior Authorization of Histamine II Receptor Blockers—Pharmacy Services 02/03/14 01-14-08
09-14-06
27-14-05
33-14-06
02-14-05
11-14-05
30-14-05
03-14-05
14-14-05
31-14-07
08-14-07
24-14-05
32-14-05Ch. 1121 Prior Authorization of Oncology Agents Oral—Pharmacy Services 02/03/14 01-14-11
09-14-09
27-14-08
33-14-09
02-14-08
11-14-08
30-14-08
03-14-08
14-14-08
31-14-10
08-14-10
24-14-08
32-14-08Ch. 1121 Prior Authorization of Epinephrine Self-Injected—Pharmacy Services 02/03/14 01-14-07
09-14-05
27-14-04
33-14-05
02-14-04
11-14-04
30-14-04
03-14-04
14-14-04
31-14-06
08-14-06
24-14-04
32-14-04Ch. 1121 Prior Authorization of Immunomodulators Topical—Pharmacy Services 02/03/14 01-14-09
09-14-07
27-14-06
33-14-07
02-14-06
11-14-06
30-14-06
03-14-06
14-14-06
31-14-08
08-14-08
24-14-06
32-14-06Ch. 1121 Prior Authorization of Iron Oral—Pharmacy Services 02/03/14 01-14-10
09-14-08
27-14-07 33-14-08
02-14-07
11-14-07
30-14-07
03-14-07
14-14-07
31-14-09
08-14-09
24-14-07
32-14-07Ch. 1121 Prior Authorization of Progestational Agents—Pharmacy Services 02/03/14 01-14-12
09-14-10
27-14-09
33-14-10
02-14-09
11-14-09
30-14-09
03-14-09
14-14-09
31-14-11
08-14-11
24-14-09
32-14-09Ch. 1150 Sample Review of Physicians Receiving Increased Fees for Select Primary Care Services 02/18/14 31-14-12 Ch. 1121 Specialty Pharmacy Drug Program—Updated List of Covered Drugs—Pharmacy Services 02/18/14 99-14-05 Ch. 1101 Provider Credentialing by the Pennsylvania Medical Assistance Program 02/27/14 99-14-02 Ch. 1101 Re-enrollment/Revalidation of Medical Assistance (MA) Providers 03/07/14 99-14-06 Ch. 1149 2014 Recommended Childhood and Adolescent Immunization Schedules 04/01/14 99-14-07 Ch. 1121 Prior Authorization of Prescriptions That Exceed Established Quantity Limits/Daily Dose Limits—Pharmacy Services 04/25/14 01-14-18
09-14-13
27-14-11
33-14-12
02-14-11
11-14-11
30-14-11
03-14-14
14-14-11
31-14-16
08-14-14
24-14-11
32-14-11Ch. 1121 Prior Authorization of Kalydeco. (ivacaftor)—Pharmacy Services 04/25/14 01-14-17
02-14-10
03-14-13
08-14-13
09-14-12
11-14-10
14-14-10
24-14-10
27-14-10
30-14-10
31-14-15
32-14-10
33-14-11Ch. 1243 Addition to the Medical Assistance Program Fee Schedule—Oncotype DX 05/06/14 01-14-16
08-14-12
09-14-11
28-14-01
31-14-14Ch. 1121 Prior Authorization of Analgesics Narcotic Long Acting—Pharmacy Services 05/30/14 01-14-24
09-14-19
27-14-17
33-14-18
02-14-16
11-14-16
30-14-16
03-14-19
14-14-16
31-14-22
08-14-20
24-14-16
32-14-16Ch. 1121 Prior Authorization of Immune Globulins—Pharmacy Services 05/30/14 01-14-25
09-14-20
27-14-18
33-14-19
02-14-17
11-14-17
30-14-17
03-14-20
14-14-17
31-14-23
08-14-21
24-14-17
32-14-17Ch. 1121 Prior Authorization of Hepatitis C Agents—Pharmacy Services 05/30/14 01-14-22
09-14-17
27-14-15
33-14-16
02-14-14
11-14-14
30-14-14
03-14-17
14-14-14
31-14-20
08-14-18
24-14-14
32-14-14Ch. 1121 Prior Authorization of Opiate Dependence Treatments—Pharmacy Services 05/30/14 01-14-21
09-14-16
27-14-14
33-14-15
02-14-13
11-14-13
30-14-13
03-14-16
14-14-13
31-14-19
08-14-17
24-14-13
32-14-13Ch. 1121 Prior Authorization of Botulinum Toxins (Type A and Type B)—Pharmacy Services 05/30/14 01-14-23
09-14-18
27-14-16
33-14-17
02-14-15
11-14-15
30-14-15
03-14-18
14-14-15
31-14-21
08-14-19
24-14-15
32-14-15Ch. 1121 Prior Authorization of Alzheimer's Agents—Pharmacy Services 05/30/14 01-14-20
09-14-15
27-14-13
33-14-14
02-14-12
11-14-12
30-14-12
03-14-15
14-14-12
31-14-18
08-14-16
24-14-12
32-14-12Ch. 1101 2014 HCPCS Updates and Other Procedure Code Changes 06/13/14 99-14-04 Ch. 1121 Preferred Drug List (PDL) Updated July 22, 2014—Pharmacy Services 07/07/14 01-14-26
09-14-21
27-14-19
33-14-20
02-14-18
11-14-18
30-14-18
03-14-21
14-14-18
31-14-24
08-14-22
24-14-18
32-14-18Ch. 1141
1150ACA Primary Care Services 2014 Fee Schedule 07/07/14 31-14-13 Ch. 1121 Prior Authorization of Hypoglycemic, Alpha-Glucosidase Inhibitors—Pharmacy Services 07/25/14 01-14-33
09-14-28
27-14-26
33-14-27
02-14-25
11-14-25
30-14-25
03-14-28
14-14-25
31-14-31
08-14-29
24-14-25
32-14-25Ch. 1121 Prior Authorization of Hypoglycemics, Metformins—Pharmacy Services 07/25/14 01-14-34
02-14-26
03-14-29
08-14-30
09-14-29
11-14-26
14-14-26
24-14-26
27-14-27
30-14-26
31-14-32
32-14-26
33-14-28Ch. 1121 Prior Authorization of Hypoglycemics, Sulfonylureas—Pharmacy Services 07/25/14 01-14-35
02-14-27
03-14-30
08-14-31
09-14-30
11-14-27
14-14-27
24-14-27
27-14-28
30-14-27
31-14-33
32-14-27
33-14-29Ch. 1121 Prior Authorization of Multiple Sclerosis Agents—Pharmacy Services 07/25/14 01-14-36
02-14-28
03-14-31
08-14-32
09-14-31
11-14-28
14-14-28
24-14-28
27-14-29
30-14-28
31-14-34
32-14-28
33-14-30Ch. 1121 Prior Authorization of Antiparasitics, Topical—Pharmacy Services 07/25/14 01-14-31
09-14-26
27-14-24
33-14-25
02-14-23
11-14-23
30-14-23
03-14-26
14-14-23
31-14-29
08-14-27
24-14-23
32-14-23Ch. 1121 Prior Authorization of Antimigraine Agents, Other—Pharmacy Services 07/25/14 01-14-29
09-14-24
27-14-22
33-14-23
02-14-21
11-14-21
30-14-21
03-14-24
14-14-21
31-14-27
08-14-25
24-14-21
32-14-21Ch. 1121 Prior Authorization of Anticoagulants—Pharmacy Services 07/25/14 01-14-28
02-14-20
03-14-23
08-14-24
09-14-23
11-14-20
14-14-20
24-14-20
27-14-21
30-14-20
31-14-26
32-14-20
33-14-22Ch. 1121 Prior Authorization of Hypoglycemics, SGLT2 Inhibitors—Pharmacy Services 07/25/14 01-14-38
02-14-30
03-14-33
08-14-34
09-14-33
11-14-30
14-14-30
24-14-30
27-14-31
30-14-30
31-14-36
32-14-30
33-14-32Ch. 1121 Prior Authorization of Nitrofuran Derivatives—Pharmacy Services 07/25/14 01-14-37
02-14-29
03-14-32
08-14-33
09-14-32
11-14-29
14-14-29
24-14-29
27-14-30
30-14-29
31-14-35
32-14-29
33-14-31Ch. 1121 Prior Authorization of Hereditary Angioedema (HAE) Agents—Pharmacy Services 07/25/14 01-14-32
09-14-27
27-14-25
33-14-26
02-14-24
11-14-24
30-14-24
03-14-27
14-14-24
31-14-30
08-14-28
24-14-24
32-14-24Ch. 1121 Prior Authorization of Thyroid Hormones—Pharmacy Services 07/25/14 01-14-39
02-14-31
03-14-34
08-14-35
09-14-34
11-14-31
14-14-31
24-14-31
27-14-32
30-14-31
31-14-37
32-14-31
33-14-33Ch. 1121 Prior Authorization of Acne Agents, Oral—Pharmacy Services 08/05/14 01-14-27
09-14-22
27-14-20
33-14-21
02-14-19
11-14-19
30-14-19
03-14-22
14-14-19
31-14-25
08-14-23
24-14-19
32-14-19Ch. 1121 Prior Authorization of Ulcerative Colitis Agents—Pharmacy Services 08/05/14 01-14-40
09-14-35
27-14-33
33-14-34
02-14-32
11-14-32
30-14-32
03-14-35
14-14-32
31-14-38
08-14-36
24-14-32
32-14-32Ch. 1121 Prior Authorization of Antimigraine Agents, Triptans—Pharmacy Services 08/05/14 01-14-30
09-14-25
27-14-23
33-14-24
02-14-22
11-14-22
30-14-22
03-14-25
14-14-22
31-14-28
08-14-26
24-14-22
32-14-22Ch. 1121 Prior Authorization of Tysabri—Pharmacy Services 08/11/14 01-14-41
09-14-36
27-14-34
33-14-35
02-14-33
11-14-33
30-14-33
03-14-36
14-14-33
31-14-39
08-14-37
24-14-33
32-14-33Ch. 1101 Implementation of National Correct Coding Initiative Related Modifiers 09/12/14 99-14-08 Ch. 1149
1150New Procedure Code for Dental Services 09/27/14 27-14-12 Ch. 1101
1150Presumptive Eligibility for Pregnant Women 10/24/14 01-14-19
08-14-15
09-14-14
31-14-17
33-14-13
47-14-02Ch. 1101 Implementation of Healthy Pennsylvania 11/04/14 99-14-09 Ch. 1101
1141
1150
1221Advanced Radiologic Imaging Services 11/21/14 01-14-42 Ch. 1123 Revisions to Prior Authorization Requirements for Apnea Monitors 12/09/14 24-14-34
25-14-01Ch. 1101 Healthy PA Benefit Plans 12/12/14 99-14-10 Ch. 1141
1150Medical Assistance Fees for Primary Care Services 12/20/14 31-14-40 Ch. 1121 Prior Authorization of Hepatitis C Agents—Pharmacy Services 12/29/14 01-14-53
02-14-43
03-14-46
08-14-47
09-14-46
11-14-43
14-14-43
24-14-44
27-14-44
30-14-43
31-14-50
32-14-43
33-14-45Ch. 1121 Prior Authorization of Anti-Allergens, Oral—Pharmacy Services 12/29/14 01-14-47
09-14-40
27-14-38
33-14-39
02-14-37
11-14-37
30-14-37
03-14-40
14-14-37
31-14-44
08-14-41
24-14-38
32-14-37Ch. 1121 Prior Authorization of Rilutek (riluzole)—Pharmacy Services 12/29/14 01-14-51
02-14-41
03-14-44
08-14-45
09-14-44
11-14-41
14-14-41
24-14-42
27-14-42
30-14-41
31-14-48
32-14-41
33-14-43Ch. 1121 Prior Authorization of Compounded Prescriptions—Pharmacy Services 12/29/14 01-14-44
02-14-34
03-14-37
08-14-38
09-14-37
11-14-34
14-14-34
24-14-35
27-14-35
30-14-34
31-14-41
32-14-34
33-14-36Ch. 1121 Prior Authorization of Cytokine and CAM Antagonists—Pharmacy Services 12/29/14 01-14-52
02-14-42
03-14-45
08-14-46
09-14-45
11-14-42
14-14-42
24-14-43
27-14-43
30-14-42
31-14-49
32-14-42
33-14-44Ch. 1121 Prior Authorization of Soliris (eculizumab)—Pharmacy Services 12/29/14 01-14-48
09-14-41
27-14-39
33-14-40
02-14-38
11-14-38
30-14-38
03-14-41
14-14-38
31-14-45
08-14-42
24-14-39
32-14-38Ch. 1121 Prior Authorization of Mozobil (Plerixafor)—Pharmacy Services 12/29/14 01-14-49
09-14-42
27-14-40
33-14-41
02-14-39
11-14-39
30-14-39
03-14-42
14-14-39
31-14-46
08-14-43
24-14-40
32-14-39Ch. 1121 Prior Authorization of Xenazine (tetrabenazine)—Pharmacy Services 12/29/14 01-14-50
02-14-40
03-14-43
08-14-44
09-14-43
11-14-40
14-14-40
24-14-41
27-14-41
30-14-40
31-14-47
32-14-40
33-14-42Ch. 1121 Prior Authorization of Xolair—Pharmacy Services 12/29/14 01-14-45
02-14-35
03-14-38
08-14-39
09-14-38
11-14-35
14-14-35
24-14-36
27-14-36
30-14-35
31-14-42
32-14-35
33-14-37Ch. 1121 Prior Authorization of Ranexa (ranolazine)—Pharmacy Services 12/29/14 01-14-46
02-14-36
03-14-39
08-14-40
09-14-39
11-14-36
14-14-36
24-14-37
27-14-37
30-14-36
31-14-43
32-14-36
33-14-38Ch. 1150
1245Non-Payment of Unloaded Ground or Air Ambulance Mileage 12/30/14 26-14-01 2015 Ch. 1101 Healthy PA Interim Benefit Plan 01/14/15 99-15-02 Ch. 1130 Hospice Services 01/19/15 06-15-01
09-14-47
31-14-51Ch. 1121 Prior Authorization of Sedative Hypnotics—Pharmacy Services 02/04/15 01-15-04
02-15-03
03-15-03
08-15-04
09-15-04
11-15-03
14-15-03
24-15-03
27-15-03
30-15-03
31-15-04
32-15-03
33-15-04Ch. 1121 Prior Authorization of Thalidomide and Derivatives—Pharmacy Services 02/04/15 01-15-06
02-15-05
03-15-05
08-15-06
09-15-06
11-15-05
14-15-05
24-15-05
27-15-05
30-15-05
31-15-06
32-15-05
33-15-06Ch. 1121 Prior Authorization of Antipsychotics—Pharmacy Services 02/04/15 01-15-03
02-15-02
03-15-02
08-15-03
09-15-03
11-15-02
14-15-02
24-15-02
27-15-02
30-15-02
31-15-03
32-15-02
33-15-03Ch. 1121 Prior Authorization of Botulinum Toxins—Pharmacy Services 02/04/15 01-15-05
02-15-04
03-15-04
08-15-05
09-15-05
11-15-04
04-15-04
24-15-04
27-15-04
30-15-04
31-15-05
32-15-04
33-15-05Ch. 1121 Addition to the Medical Assistance Program Fee Schedule for Administration of Quadrivalent—Influenza Vaccine 02/18/15 01-15-01
08-15-01
09-15-01
31-15-01
33-15-01Ch. 1121 Preferred Drug List (PDL) Update January 21, 2015—Pharmacy Services 02/18/15 01-15-02
09-15-02
27-15-01
33-15-02
02-15-01
11-15-01
30-15-01
03-15-01
14-15-01
31-15-02
08-15-02
24-15-01
32-15-01Ch. 1163 Revised Presumptive Eligibility as Determined by Hospitals 02/24/15 01-15-08 Ch. 1101 Medical Assistance Program Fee Schedule Revisions 03/02/15 99-15-01* Ch. 1101 Medical Assistance Program Fee 03/17/15 99-15-03 Ch. 1101
1150
1225Payment Increase for the Title XIX Medical Assistance Program Family Planning Clinics that Dispense Oral Contraceptives 03/23/15 08-15-08 Ch. 1241 2015 Recommended Childhood and Adolescent Immunization Schedules 03/23/15 99-15-04 Ch. 1150
1245Non-Payment of Unloaded Ground or Air Ambulance Mileage 03/23/15 26-15-01 Ch. 1121 Implementation of HealthChoices Medicaid Expansion 04/28/15 99-15-05 Ch. 1121 Prior Authorization of Idiopathic Fibrosis Agent—Pharmacy Service 05/11/15 01-15-14
02-15-12
03-15-12
08-15-14
09-15-13
11-15-12
14-15-12
24-15-12
27-15-12
30-15-12
31-15-13
32-15-12
33-15-13Ch. 1121 Prior Authorization of Hypoglycemics, Insulin—Pharmacy Services 05/11/15 01-15-10
02-15-08
03-15-08
08-15-10
09-15-09
11-15-08
14-15-08
24-15-08
27-15-08
30-15-12
31-15-13
32-15-12
33-15-13Ch. 1121 Prior Authorization of Intra-Articular Hyaluronic Acid Agents—Pharmacy Service 05/11/15 01-15-12
02-15-10
03-15-10
08-15-12
09-15-11
11-15-10
14-15-10
24-15-10
27-15-10
30-15-10
31-15-11
32-15-10
33-15-11Ch. 1121 Prior Authorization of Santyl Ointment (collagenase)—Pharmacy Service 05/11/15 01-15-13
02-15-11
03-15-11
08-15-13
09-15-12
11-15-11
14-15-11
24-15-11
27-15-11
30-15-11
31-15-12
32-15-11
33-15-12Ch. 1121 Prior Authorization of Multiple Sclerosis Agents—Pharmacy Services 05/11/15 01-15-09
02-15-07
03-15-07
08-15-09
09-15-08
11-15-07
14-15-07
24-15-07
27-15-07
30-15-07
31-15-08
32-15-07
33-15-08Ch. 1121 Prior Authorization of Antifungals, Topical—Pharmacy Services 06/22/15 01-15-17
02-15-14
03-15-14
08-15-17
09-15-17
11-15-14
14-15-14
24-15-15
27-15-14
30-15-14
31-15-17
32-15-14
33-15-16Ch. 1121 Prior Authorization of Anticoagulants—Pharmacy Services 06/22/15 01-15-16
02-15-13
03-15-13
08-15-16
09-15-16
11-15-13
14-15-13
24-15-14
27-15-13
30-15-13
31-15-16
32-15-13
33-15-15Ch. 1121 Prior Authorization of GI Motility, Chronic Agents (Formerly Irritable Bowel Syndrome Agents)—Pharmacy Services 06/25/15 01-15-18
02-15-15
03-15-15
08-15-18
09-15-18
11-15-15
14-15-15
24-15-16
27-15-15
30-15-15
31-15-18
32-15-15
33-15-17Ch. 1121 Preferred Drug List (PDL) Update July 20, 2015—Pharmacy Services 06/25/15 01-15-23
02-15-20
03-15-20
08-15-23
09-15-23
11-15-20
14-15-20
24-15-21
27-15-20
30-15-20
31-15-23
32-15-20
33-15-22Ch. 1121 Prior Authorization of Platelet Aggregation Inhibitors—Pharmacy Services 06/25/15 01-15-20
02-15-17
03-15-17
08-15-20
09-15-20
11-15-17
14-15-17
24-15-18
27-15-17
30-15-17
31-15-20
32-15-17
33-15-19Ch. 1121 Prior Authorization of Contraceptives, Other—Pharmacy Services 06/25/15 01-15-19
02-15-16
03-15-16
08-15-19
09-15-19
11-15-16
14-15-16
24-15-17
27-15-16
30-15-16
31-15-19
32-15-16
33-15-18Ch. 1121 Prior Authorization of Hypoglycemics, SGLT2 Inhibitors—Pharmacy Services 06/25/15 01-15-22
02-15-19
03-15-19
08-15-22
09-15-22
11-15-19
14-15-19
24-15-20
27-15-19
30-15-19
31-15-22
32-15-19
33-15-21Ch. 1127
1141
1221
1225Family Planning Services 06/29/15 01-15-15
08-15-15
09-15-15
24-15-13
25-15-01
28-15-01
31-15-15
33-15-14Ch. 1121 Prior Authorization of Hepatitis C Agents—Pharmacy Service 06/30/15 01-15-21
02-15-18
03-15-18
08-15-21
09-15-21
11-15-18
14-15-18
24-15-19
27-15-18
30-15-18
31-15-21
32-15-18
33-15-20Ch. 1121 Prior Authorization of Opiate Dependence Treatments—Pharmacy Service 07/13/15 01-15-11
02-15-09
03-15-09
08-15-11
09-15-10
11-15-09
14-15-09
24-15-09
27-15-09
30-15-09
31-15-10
32-15-09
33-15-10Ch. 1121 Preferred Drug List (PDL) Update July 20, 2015 Corrections—Pharmacy Services 08/07/15 01-15-26
02-15-23
03-15-23
08-15-26
09-15-26
11-15-23
14-15-23
24-15-24
27-15-23
30-15-23
31-15-26
32-15-23
33-15-25Ch. 1241 Revisions to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program
Periodicity Schedule08/10/15 99-15-07
Ch. 1101
1150Prior Authorization Requirements and Fee Schedule Updates for Hyperbaric Oxygen Therapy 08/31/15 01-15-30
14-15-25
31-15-30
Ch. 1101
11502015 HCPCS Updates and Other Procedure Codes 08/31/15 99-15-06 Ch. 1101
1150Procedure Code Changes for Application of Topical Fluoride Varnish by Physicians and CRNPs 09/01/15 09-15-14
31-15-14
Ch. 1126
1129
1151
1181
1187
1189Provider Preventable Conditions 09/01/15 01-15-28
03-15-24
09-15-28
18-15-02 31-15-28 33-15-27 02-15-24 08-15-28 14-15-24 27-15-24 32-15-24 47-15-01
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