[54 Pa.B. 4621]
[Saturday, August 3, 2024]
[Continued from previous Web Page] (Editor's Note: This document continues from Part III which begins at 54 Pa.B. 4621 (August 3, 2024).)
Year Code
CitationSubject Date Issued Bulletin Number Ch. 2800 Assisted Living Residence Per Bed Fee Adjustment 06/19/18 48 Pa. B 3493 Ch. 2600 and 2800 Human Services Licensing: Definition of Personal Care Home and Assisted Living Residence 10/20/18 48 Pa.B. 6654 2019 Hearings and Appeals 02/11/2019 59-19-03 Implementation of the Functional Eligibility Determination Process 04/01/2019 IEB-19-04 IAE-19-04 07-19-04 CH 52 Medical Assistance Fee Schedule Revisions in the OBRA Waiver 08/24/2019 49 Pa.B. 4913 CH 52 Medical Assistance Fee Schedule Revisions to the Act 150 Program 11/30/2019 49 Pa.B. 7136 Revised Target Resident (MH, ID/DD, ORC) Reporting Form 12/30/2019 03-19-05 2020 Employment and Employment Related Services 07/09/2020 17-20-02 Revised Standardized Physician Certification Form (MA 570) 08/10/2020 59-20-03 Electronic Visit Verification (EVV) for Personal Care Services (PCS) 09/10/2020 07-20-04, 54-20-04, 59-20-04, 00-20-03 2021 Act 150 Program Sliding Fee Scale for Calendar Year 2021 03/25/2021 54-21-01, 59-21-01 Opioid Treatment Program Services for Dually Eligible Individuals 7/08/21 OMHSAS-21-06 Updated Error Status Code Descriptions for Personal Care Services Subject to Electronic Visit Verification 10/22/21 05-21-04, 07-21-01, 54-21-02, 59-21-02, 00-21-03 Ch. 52 Medical Assistance Fee Schedule Revisions in the OBRA Waiver and the Act 150 Program 11/06/21 51 Pa.B. 7001 Act 150 Program Sliding Fee Scale for Calendar Year 2022 12/22/21 54-21-04 59-21-04 Home and Community-Based Settings Heightened Scrutiny Process 12/29/21 59-21-03 2022 Electronic Visit Verification Requirements for Home Health Care Services in the Fee-for-Service Delivery and Managed Care Delivery System 08/10/22 05-22-09 07-22-03 54-22-01 59-22-01 00-22-06 2023 Act 150 Program Sliding Fee Scale for Calendar Year 2023 01/01/23 54-23-01 59-23-01 Critical Incident Management 02/23/23 05-23-02 51-23-02 54-23-02 55-23-02 59-23-02 Employment and Employment Related Services 06/14/23 07-23-04 2024 2024 Act 150 Sliding Fee Scale 1/17/24 54-24-01 59-24-01 Revised PASRR positive Resident (MH, ID/DD, ORC) Reporting Form (MA 408) 3/1/24 03-24-03 Revised PASRR Level Identification Form (MA 376) 3/1/24 01-24-02 03-24-02 07-24-02 59-24-02 GUIDANCE MANUALS:
Fee-for-Service/Home and Community Based Services
• OBRA Medicaid Waiver # 0235
Community HealthChoices Managed Care Program
• Community HealthChoices 1915(b) waiver—effective January 1, 2022
• Community HealthChoices 1915(c) waiver # 0386—effective April 1, 2023
• Community Health Choices Agreement 2023
Nursing Facility
• Interpretive Guidelines—interpretations of the 1187 Nursing Facility regulations used during audits of the MA-11 Cost Reports
• Instructions for Financial and Statistical Report-Form MA-11
• MA-11 Cost Report Submission System—End User Manual V.6.0
• Nursing Facility Assessment End User Manual
• Resident Data Reporting Manual
• UB-04 Billing Guide for PROMISeTM Nursing Facilities for County and Nonpublic Nursing Facilities and State Restoration Centers—Nursing facility services only applies to county nursing facilities and nonpublic nursing facilities. Regulations related to payment for nursing facility services can be found under 55 Pa. Code Chapters 1187 and 1189 and does not include intermediate care facilities for persons with an intellectual disability, Federal or State-owned long-term care nursing facilities or Veteran's homes.
• Data Book (Office of Long-Term Living Workbook)
• Out-of-State Residents Seeking PA Long-Term Nursing Facility Care Process
• PASRR Clarifications and Frequently Asked Questions—September 2018Personal Care Homes/Assisted Living Residences
• Regulatory Compliance Guide for 55 Pa. Code Chapter 2600 (relating to Personal Care Homes) Revised August 1, 2021
• Regulatory Compliance Guide for 55 Pa. Code Chapter 2800 (relating to Assisted Living Residences) Revised August 1, 2021
• Licensing References Manual for Personal Care Homes, Assisted Living, Child Residential, Intellectual Disabilities, and Mental Health Service Providers
• Use of Voice-Controlled Electronic Devices-Guidance—August 31, 2022
• Frequently Asked Questions about Personal Care Homes
• Frequently Asked Questions About Unlicensed Personal Care Homes
• Serving as a Master in a Personal Care Home
• Use of the Term "Assisted Living" by Personal Care Homes—September 2, 2016
• Effective Plan of Correction Guide—April 19, 2022
• Use of Bedside Mobility Devices in Personal Care Homes and Assisted Living Residences—June 26, 2023Covid-19 Guidance
• Temporary Changes to 811 Project Rental Assistance (PRA) Program—March 31, 2020
• CARES Act Funding for OLTL Home and Community-Based Services Providers—June 22, 2020
• CARES Act Funding for OLTL Community HealthChoices Managed Care Organizations (CHC-MCOs) and Living Independence for the Elderly (LIFE) Organizations—June 22, 2020
• CARES Act Funding for OLTL for Licensed Personal Care Home (PCH) and Licensed Assisted Living Residences (ALR) Providers—June 22, 2020
• CARES Act Funding for OLTL Nursing Facility Providers—July 6, 2020Office of Medical Assistance Programs—Contact: Eve Lickers (717) 772-6341
POLICY STATEMENTS:
Year Code Citation(s) Subject Date Issued Bulletin Number 1981 Ch. 1251 Clarification of M.A. Bulletin # 22-80-01 08/19/81 22-81-01 Ch. 1121 Info. Concerning Claims Submitted as Compounded Prescriptions 06/30/82 19-82-02 1984 Ch. 1251 Revisions to MA Chapter 1251 (Funeral Directors' Services) 05/11/84 22-84-01 1984 Ch. 1101 Third Party Resource and Copay 11/01/84 99-84-15 1985 Ch. 1141 Physician Assistant Use 04/22/85 01-85-05 Ch. 1101 Allergy Testing—Exemptions from Co-Payments 10/15/85 01-85-18
11-85-20
12-85-11
10-85-02Ch. 1101 Professional Component Billing Regarding Patient Transport 10/15/85 01-85-16 Ch. 5100 Requirements for Treatment Plans Documentation of Treatment 10/31/85 29-85-02
33-85-021986 Ch. 1141 Payment Policy for Abortion Clinic
Visits09/10/86 10-86-02
11-86-10Ch. 1101 Policy Clarification Re: Provider's Signature 09/19/86 99-86-06 Ch. 1150 Payment Policy for Consultations 10/23/86 03-86-07 Ch. 1101 Preclusion of Convicted Persons, Not Providers, from Participation or Involvement in the MA Program 10/24/86 99-86-09 Ch. 1123 Durable Medical Equipment Warranties 10/28/86 05-86-02
19-86-071987 Ch. 1101 Physicians' Responsibility when Ordering Home Health Services 01/12/87 01-87-01 Ch. 1149 Palliative Emergency Treatment 04/24/87 03-87-02
27-87-01Ch. 1187 Barber and Beauty Costs 05/15/87 35-87-04
36-87-01Ch. 1101
Ch. 1123Coverage for Motorized Wheelchairs 07/30/87 05-87-02
01-87-08
19-87-06Ch. 1123 Policy Relating to Apnea Monitors 09/02/87 01-87-15
05-87-04
19-87-09Ch. 1187 Barber and Beauty Costs 10/22/87 35-87-07
36-87-08Ch. 140 Use of the PA 162 Forms for Notification of Medical Assistance Eligibility 10/22/87 99-87-10 Ch. 5310 Medical Assistance Coverage for Recipients Residing in Community Residential Facilities 10/23/87 99-87-11 Ch. 1150 Time Limit for Claim Resubmissions and Recovery of Overpayments 11/03/87 99-87-12 1988 Ch. 1150 Place of Service Review (PSR) Program 01/04/88 01-88-01
03-88-01
04-88-01
06-88-01
08-88-01
11-88-01Ch. 1150 Place of Service Review (PSR) Program 03/04/88 01-88-02
03-88-02
04-88-02
06-88-02
08-88-02
11-88-03Ch. 140 Healthy Beginning—Presumptive Eligibility Program 04/01/88 99-88-04 Ch. 1123 List of Accredited Rehabilitation Facilities to be used for Motorized Wheelchair Evaluation 04/06/88 01-88-04
05-88-02
19-88-03Ch. 150 Medical Assistance Eligibility Change for Aliens 04/13/88 99-88-05 Ch. 1151 Revisions to Chapters 1151 and 1163 Regulations 06/29/88 11-88-02
12-88-05
13-88-05
1151-88-02
1163-88-02Ch. 1101 Policy Clarification Regarding Physician License 07/01/88 1101-88-01 Ch. 1223 Revision of Inpatient Hospital Drug and Alcohol Detoxification Payment Policy 09/09/89 01-88-11
11-88-11
1163-88Ch. 1150 Desk Reference 10/06/88 29-88-01
33-88-011989 Ch. 140 Healthy Horizons and Medicare Cost Sharing 01/04/89 99-89-02 Ch. 1150 Billing Instructions—Services Covered Only by Medicare 05/18/89 99-89-03 — Signature Requirements and Encounter Forms 05/26/89 99-89-05 Ch. 1150 Proper Use of Place of Service Codes 07/05/89 03-89-05 Ch. 1101 Policy Reminder Regarding Practitioner License Requirements 1101-89-02
03-89-08
04-89-07
07-89-02
15-89-02
31-89-02Ch. 1101 1150 Penalty for Bypassing Place of Service Review 11/03/89 01-89-09
03-89-06
04-89-05 06-89-04
08-89-04
11-89-10Ch. 1150 Michael Dallas Model Waiver Program for Technology—
Dependent Children11/03/89 99-89-13 Ch. 1247 Targeted Case Management Services 11/13/89 99-89-12
1247-89-01— Additional Category Eligible for Medicare-Cost Sharing Benefits 12/27/89 99-89-15 1990 Ch. 1121 Special Billing Instructions for Persantine 01/19/90 01-90-01 Ch. 1150
1163
1249
1121
1126AIDS Waiver Program 04/02/90 01-90-02
02-90-01
05-90-02
19-90-01
23-90-01
38-90-01
39-90-01Ch. 1150 Payment Policy for Consultations 04/27/90 1150-90-01 Ch. 1150 The Medicare Catastrophic Coverage Act of 1988 the Medicare Catastrophic Coverage Repeal Act of 1989 05/18/90 34-90-09 Ch. 1140 Provider Participation Requirements for Healthy Beginning Plus 06/12/90 1140-90-01
01-90-06
09-90-01
10-90-02
11-90-04
23-90-05
26-90-02
30-90-02
31-90-01Ch. 1163 Inpatient Hospital Services Retrospective Review Findings 07/09/90 11-90-08
12-90-03
13-90-02Ch. 1144 Certified Registered Nurse Practitioner 07/31/90 99-90-05
1144-90-01— Increase in Eligibility Guidelines 08/15/90 99-90-06 Ch. 1241 EPSDT Services 10/15/90 99-90-07
1241-90-01Ch. 1141 Allergen Immunotherapy 1991 Ch. 1141
1149
1143
1221Billing Procedures—Multiple Surgical Surgical/Obstetrical and Anesthesia Procedures 03/01/91 01-91-01
03-91-01
04-91-01
10-91-01
11-91-01
44-91-01
49-91-01Ch. 1123 Incontinence Products and Diapers 03/21/91 01-91-02
02-91-01
05-91-01
19-91-01
23-91-01Ch. 1121 Manufacturers' Rebate Program Corrections and Clarifications 05/20/91 01-91-07
02-91-03
03-91-05
04-91-05
10-91-04
11-91-06
12-91-03
19-91-05
26-91-03
28-91-02
29-91-02
30-91-02
33-91-02
49-91-03Ch. 1121 Manufacturers' Rebate Program 05/31/91 01-91-08
02-91-04
03-91-06
04-91-06
10-91-05
11-91-07
12-91-04
19-91-06
26-91-04
28-91-03
29-91-03
30-91-03
33-91-03
49-91-04— Certification of Need—Medical Assistance Patients Under the Age of 21 06/24/91 13-91-01 Ch. 1101 Lock-In Enhanced Recipient Restriction Program 07/12/91 99-91-04 — Third Party Resources Edits 608 and 616 07/26/91 99-91-05 *CH. 1101
CH. 1121
CH. 1123
CH. 1241EPSDT—OBRA '89 08/02/91 1101-91-01
1121-91-02
1123-91-01
1241-91-01Ch. 1123 Repair and Replacement of Durable Medical Equipment (DME), Orthotics and Prosthetics 10/01/91 05-91-04
19-91-14Ch. 1101
1150
1241Payments for Vaccines 11/06/91 1221-91-01 Ch. 1121 Clorazil Monitoring and Evaluation Visit 11/06/91 29-91-07
1153-91-011992 Ch. 1221 Billing for Emergency Room Services for Recipients Who Are Hospitalized On the Same Day 01/17/92 11-92-02
13-92-01
12-92-01
53-92-01Ch. 1147 Increased Fees for Vision Services 01/31/92 01-92-02
05-92-01
15-92-01
19-92-02*Ch. 1141
*Ch. 1153Clozapine Support Services 01/31/92 1141-92-01
1153-92-01
01-92-04
29-92-02
33-92-04— Independent Team—Certification of Need—Medical Assistance Patients Under the Age 21 02/21/92 13-92-03 Ch. 1149 Dental Management Fee Guidelines 02/21/92 03-92-03 Ch. 1147 Clarification of Vision Services 04/17/92 01-92-05
05-92-02
15-92-03
19-92-04Ch. 1181 Reimbursement for Hospital Reserved Bed Days During a Medicare Benefit Period 05/01/92 1181-92-04 — Qualified Medicare Beneficiary Healthy Horizons Program 06/19/92 99-92-03 Ch. 1163 Inpatient Hospital Services Retrospective Review Findings 07/03/92 11-92-11
12-92-11
13-92-07
53-92-05Ch. 1163 Automated Admission Certification 07/22/92 01-92-12
03-92-05
04-92-04Ch. 1163 Hospital Utilization Review Changes 07/22/92 06-92-01
08-92-01
11-92-12
12-92-12
13-92-08
53-92-06Ch. 1126 Increase in Hospital Special Treatment Room Support Component—Payment For Observation and Monitoring in ASC's and SPU's 08/11/92 06-92-02
08-92-02
11-92-13Ch. 1121 Norplant Coverage 12/07/92 01-92-20
10-92-10
11-92-21
30-92-06Ch. 1101 Basic Health Care for Adult General Assistance Recipients 12/23/92 99-92-07 Ch. 1121 Changes in Medical Assistance Pharmaceutical Benefits 12/23/92 01-92-19
02-92-03
03-92-08
04-92-09
10-92-09
11-92-20
12-92-16
19-92-15
26-92-05
28-92-03
29-92-03
30-92-05
33-92-04
49-92-081993 — Accessing Mental Health Services Not Currently Included in the Medical Assistance Fee Schedule for Eligible Children and Adolescents Under 21 Years Of Age 01/19/93 01-93-03
29-93-02
33-93-02
41-93-01
48-93-01— Payment for Mental Health Services Provided in a Residential Treatment Facility for Eligible Individuals Under 21 Years of Age 01/19/93 01-93-04
11-93-02
13-93-02
41-93-02
53-93-02
1165-93-07— Enrollment Procedure Changes 01/22/93 29-93-01
33-93-01Ch. 1101 Interim Agreement Felix et al. v. Casey et al. 01/28/93 99-93-01
1101-93-02Ch. 1123 Reminder that Medical Equipment and Supplies Must Be Prescribed 01/29/93 01-93-02
03-93-01
04-93-01
05-93-01
07-93-01
19-93-02Ch. 1101 Additional Copayment Expenses 02/17/93 01-93-01
19-93-01
1101-93-01Ch. 1123 Prior Authorization Rental of Nebulizers 04/09/93 01-93-06
05-93-03
19-93-04Ch. 1121 Intrauterine Devices 05/13/93 01-93-09
10-93-01
11-93-04Ch. 1101
1150Voucher System for the General Assistance Basic Health Care Package Update 06/30/93 01-93-12
04-93-04
07-93-03
10-93-04
11-93-07
15-93-02
19-93-09
26-93-04
30-93-03
49-93-04*CH. 1121 CHANGES IN THE MEDICAL ASSISTANCE PHARMACEUTICAL BENEFITS 07/09/93 1121-93-01 *CH. 1149 DENTAL SERVICES FOR ADULTS 07/09/93 1149-93-01 Ch. 1150 Revised Definition for Established Patient Evaluation and Management Visit and Consultation 07/13/93 01-93-14
04-93-05*CH. 1101 BASIC HEALTH CARE FOR ADULT GENERAL ASSISTANCE RECIPIENTS (FELIX ET. AL. V. CASEY ET. AL.) STIPULATION OF SETTLEMENT 07/21/93 1101-93-03 *CH. 1101 UPDATE TO EXCEPTIONS PROCESS AND CRITERIA UNDER THE GENERAL ASSISTANCE BASIC HEALTH CARE PACKAGE 07/21/93 1101-93-04 Ch. 1147 Specific Procedure Code for Deluxe Eyeglass Frames 08/02/93 01-93-16
05-93-05
15-93-04
19-93-12Ch. 1163 Change in Automated Utilization Review Toll-Free Telephone Number 08/04/93 01-93-17
03-93-06
04-93-07
06-93-01
08-93-01
11-93-10
12-93-05
13-93-04
26-93-05
53-93-03Ch. 1241 Centers for Disease Control Blood Lead Testing 09/03/93 1241-93-01
01-93-18
10-93-06
11-93-12
17-93-02
26-93-06
49-93-06Ch. 1101 Business Arrangements Between Nursing Facilities and Pharmacy Providers 10/08/93 1101-93-05
19-93-16
25-93-01
35-93-03
36-93-03Ch. 1101
1150Payment Policy for the Professional Component of Radiology Services and Electrocardiograms 10/29/93 01-93-19
11-93-13
12-93-06
13-93-05
53-93-04Ch. 1101
1150Procedures for Submitting Invoices for Services Provided to Retroactively Eligible Newborns 12/06/93 99-93-11 Ch. 1101
1150Newborn Eligibility Update and Corrections to Previous Bulletins 12/20/93 09-93-02
11-93-15
31-93-02Ch. 1101
1150Newborn Eligibility Update 12/20/93 99-93-14 Ch. 1245 Payment for Non-emergency Transportation for Nursing Home Patients 12/27/93 18-93-01 — OBRA Procedures for Individuals with Mental retardation 12/30/93 00-93-30 1994 EVS Response Worksheet (MA 464) 01/20/94 99-94-01 Ch. 1101 General Assistance (GA) Basic Health Care Package Voucher System and Rejected Invoices 03/02/94 01-94-03
04-94-01
07-94-01
10-94-01
11-94-02
15-94-01
19-94-02
26-94-01
30-94-01
49-94-02Ch. 1101 General Assistance (GA) Basic Health Care Package Voucher System and Rejected Invoices 03/02/94
04-49-01
07-94-01
10-94-01
11-94-02
15-94-01
19-94-02
26-94-01
30-94-01
49-94-02— 1. ACCESS to Medical Assistance for Children, Pregnant Women and Their Families (PA 600C)
2. Provider Application for Benefits (PA 600P)03/31/94 99-94-05 — Implementation of the Family Care Network: A Primary Care Case Management Program for Children and Adolescents 04/01/94 99-94-06 — Plan of Care Summary 04/01/94 01-94-05
41-94-02
48-94-02
49-94-03
50-94-02Ch. 1241 Update to Blood Lead Testing Guidelines 04/08/94 1241-94-01 Ch. 1123 Audiological Services 04/28/94 01-94-08
05-94-03
11-94-06
19-94-04
50-94-03— Billing Procedures for Partial Hospitalization Services that Exceed the Total Number of Hours 04/29/94 33-94-01 Ch. 1149 Provider Training on Completing the Dental Services Invoice (MA 300D) 05/05/94 03-94-02 — Medicare Part B Crossover 05/05/94 99-94-07 *CH. 1239 MA CASE MANAGEMENT SERVICES FOR RECIPIENTS UNDER THE AGE OF 21 05/17/94 1239-94-01
99-94-08Ch. 1249 Procedures for Prior Authorization of Home Health Services 06/10/94 23-94-04 Ch. 1121 Discontinuance of Pharmacy Vouchers for General Assistance Recipients and Enforcement of Limits 06/24/94 01-94-13
19-94-09*CH. 1121 PHARMACEUTICAL SERVICES DRUG COVERAGE FOR MEDICALLY NEEDY IN NURSING FACILITIES 06/24/94 1121-94-01 Ch. 1121 Brand Medically Necessary Drugs Prior Authorization Billing Procedure and Drug List 07/01/94 19-94-10 Ch. 1121 Brand Medically Necessary Drugs Prior Authorization Request Procedure and Drug List 07/01/94 01-94-15
03-94-03
04-94-04— Medical Case Management Recordkeeping Forms 07/06/94 99-94-11 Ch. 1147 Proper Billing of Tonography and Provocative Test for Glaucoma 07/14/94 01-94-14
15-94-03*CH. 1121 PHARMACEUTICAL SERVICES PRIOR AUTHORIZATION REQUIREMENT MULTISOURCE BRAND NAME DRUGS 08/26/94 1121-94-02
01-94-17
03-94-04
04-94-05
19-94-11*CH. 1121
CH. 1126
CH. 1129
CH. 1141
CH. 1163
CH. 1221
CH. 1225
CH. 1242TREATMENT OF INFERTILITY—DISCONTINUED COVERAGE FOR DRUGS AND RELATED SERVICES 08/30/94 1121-94-03
1126-94-01
1129-94-01
1141-94-01
1163-94-01
1221-94-01
1225-94-01
1242-94-01
99-94-13*CH. 1101 GENERAL ASSISTANCE RESTRUCTURE AS A RESULT OF ACT 49 09/02/94 1101-94-01
99-94-14Medicare Deductible and Coinsurance Amounts for Medical Supplies for Residents in a Nursing Home 09/02/94 05-94-07
19-94-13Ch. 1141
1143Selected Office Surgical Procedures Performed in the Office 09/02/94 01-94-19
04-94-06— Clarification Bulletin 18-93-01 09/23/94 18-94-01 Ch. 1150 Revised Billing Instructions for the HCFA1500 11/14/94 99-94-15 *CH. 1153 PRIOR AUTHORIZATION OF PARTIAL HOSPITALIZATION 12/30/94 1153-94-01 1995 — Signature Requirements 02/01/95 01-95-01
29-95-01
33-95-01
41-95-01
49-95-01
50-95-01— Payment of Partial Hospitalization Services After Medicare 02/14/95 33-95-02 — AIDS Waiver Program (0192 Waiver Program); the Physician's Role in Recipient Enrollment 02/23/95 01-95-02
02-95-01
10-95-01
11-95-01— Implementation of the Lancaster Community Health Plan 03/27/95 99-95-02 — Reimbursement of Nurse Aide Training and Testing Fees 04/06/95 34-95-01
35-95-01
36-95-01
1181-95-01— Nutritional Consultations under the AIDS Waiver Program (0192 Waive) 04/26/95 01-95-05
02-95-03
10-95-02
11-95-02
23-95-02
27-95-01
28-95-01
30-95-01
38-95-01
39-95-01— Changes to the Services Available Under the AIDS (0192) Waiver Program 05/12/95 01-95-06
02-95-05
05-95-02
10-95-03
11-95-03
17-95-01
19-95-03
23-95-03
27-95-02
28-95-02
30-95-02
38-95-02
39-95-02Ch. 1141 Mammography Quality Standards Act (MQSA) 06/02/95 01-95-09
10-95-05
11-95-06
12-95-02
20-95-02
30-95-05— 1. Announcement of New Forms Printing Contractor
2. Instructions on Ordering Medical Assistance (MA) Forms07/14/95 99-95-06 Ch. 1121 Prescription Payment Systems Revisions 09/22/95 01-95-14
19-95-05Ch. 1141 Payment for Cleft Palate Services for Individuals Under 21 Years of Age 10/06/95 01-95-16
03-95-03
41-95-05
50-95-05Ch. 1221 Non-Emergency Use of the Emergency Room 10/13/95 01-95-19
11-95-11
12-95-06— Announcement of the Pennsylvania Department of Aging (PDA) Waiver 10/16/95 01-95-17
05-95-04
18-95-01
19-95-06Changes to the Eligibility Verification System 11/22/95 99-95-08 — Additional Benefits Covered by the Special Pharmaceutical Benefits Program 11/30/95 01-95-22
02-95-07
05-95-06
11-95-14
13-95-03
14-95-03
19-95-08
23-95-10
26-95-03
27-95-03
29-95-06
32-95-09
33-95-07
35-95-08
36-95-08
49-95-03CH. 1163 Payment Policy for Abortion Services 12/15/95 1163-95-02 Ch. 1221 Change in Billing Procedure for Emergency Room Visits 12/28/95 01-95-23 1996 Ch. 1121 Brand Name Drugs Prior Authorization 0 Updated List 01/19/96 01-96-01
02-96-01
03-96-01
04-96-01
10-96-01
11-96-01
12-96-01
19-96-01
26-96-01
28-96-01
29-96-01
30-96-01
33-96-01
49-96-01— The Addition of Invirase to the Special Pharmaceutical Benefits Program Formulary 03/01/96 01-96-06 02-96-04 11-96-05 19-96-06 23-96-02 26-96-05 28-96-04 30-96-04 35-96-03 36-96-03 37-96-01 45-96-01 49-96-05 Ch. 1141 Rate Change for Pediatric Office Visits 02/05/96 01-96-02
10-96-02
11-96-02
26-96-02
49-96-02
50-96-01— Continuity of Prior Authorized Services Between Fee-for-Service and Managed Care Plans for Individuals Under Age 21 02/29/96 99-96-01 — Revisions to Billing Instructions for the Pennsylvania Department of Aging (PDA) Waiver 04/01/96 01-96-07
05-96-02
18-96-01
19-96-07
23-96-03
28-96-05
29-96-04
33-96-04
39-96-01Ch. 1121 Procedure to Request Prior Authorization for Anti-Ulcer Drugs 04/02/96 01-96-05
02-96-03
03-96-03
04-96-03
10-96-04
11-96-04
12-96-03
26-96-04
28-96-03
29-96-03
30-96-03
33-96-03
49-96-04Ch. 1121 Procedure to Bill Anti-Ulcer Drugs Requiring Prior Authorization 04/02/96 19-96-05 Ch. 1121 Prior Authorization of Anti-Ulcer Drugs 04/02/96 01-96-08
02-96-05
03-96-04
04-96-04
10-96-05
11-96-07
12-96-05
19-96-08
26-96-06
28-96-06
29-96-05
30-96-06
33-96-05
49-96-06Ch. 1101
1150Hearing Aid Batteries Added to Medical Assistance Program Fee Schedule 04/02/96 03-96-09
05-96-03
11-96-08
19-96-09
50-96-02Procedure for Service Description 04/29/96 01-96-11
41-96-01
48-96-01
50-96-04— InterQual Intensity/Severity/Discharge (ISD) Criteria for Review of Hospital Admissions 05/22/96 01-96-13
11-96-12
13-96-01— Provider Billing Information for the Family Care Network (FCN) Program 05/23/96 99-96-04 — Implementation of Act No. 1996-35 06/14/96 99-96-05 Ch. 1141 Clarification of the Rate Change for Pediatric Office Visits Bulletin 07/19/96 01-96-16
10-96-08
11-96-15
26-96-09
49-96-08
50-96-06— HealthCare Benefits Package 12 Employability Assessment Procedure Code List 08/19/96 01-96-17
10-96-09
11-96-17
12-96-11
15-96-02
16-96-03
20-96-02
26-96-10
28-96-08
29-96-07
49-96-09— Additions to the Special Pharmaceutical Benefits Program Drug Formulary 09/03/96 01-96-18
02-96-06
05-96-05
11-96-18
13-96-04
14-96-03
19-96-15
23-96-06
26-96-11
27-96-01
29-96-08
32-96-01
33-96-06
35-96-08
36-96-08
49-96-10Ch. 1101 GA and GA-related Medical Assistance Deductible Procedures 09/30/96 06-96-03
08/96-03
11-96-20
12-96-13
13-96-06
53-95-02Ch. 1241 Statewide Implementation of the Vaccines for Children (VFC) Program 10/04/96 01-96-19
10-96-10
11-96-21
26-96-12Ch. 1149 Information on New Procedures for Submitting Evaluating Orthodontic Prior Authorization Requests 10/21/96 03-96-06 Ch. 1163
1141Neonatal Intensive Care Procedure Costs 10/25/96 01-96-20 — Healthcare Benefit Package 12 Employability Assessment Update 11/15/96 01-96-22
10-96-12
11-96-23
12-96-15
15-96-03
16-96-04
20-96-03
26-96-14
28-96-09
29-96-09
49-96-11— Implementation of the HealthChoices Program 11/18/96 99-96-08 Ch. 1141 Revision to Physician Assistant and Midwife Supervision Requirements 11/22/96 01-96-21
02-96-07
06-96-04
08-96-04
09-96-01
10-96-11
11-96-22
12-96-14
25-96-02
26-96-13
30-96-08
37-96-02
38-96-01
1141-96-01— Clarification of Act 35 Issues 12/04/96 01-96-23
10-96-13
11-96-24
12-96-16
13-96-07
14-96-04
26-96-15
28-96-10
29-96-10— Special Pharmaceutical Benefits Program Automated Claims Processing System 12/11/96 01-96-24
02-96-08
05-96-06
11-96-25
13-96-08
14-96-05
19-96-16
23-96-07
26-96-16
29-96-11
32-96-02
33-96-07
49-96-121997 Ch. 1145 Change in Recipient Access to Chiropractic Services in the Family Care Network (FCN) Program 02/12/97 99-97-02 Ch. 1121 HealthChoices Protease Inhibitors Special Billing Procedure 02/21/97 19-97-02 Ch. 1121 Prospective Drug Use Review Therapeutic Duplication Screening 02/21/97 19-97-01 — Expansion of the Pennsylvania Department of Aging (PDA) Waiver 02/28/97 23-97-01
28-97-01
29-97-01
33-97-01— Expansion of the Pennsylvania Department of Aging (PDA) Waiver 02/28/97 01-97-02
05-97-01
18-97-01
19-97-03
55-97-01— Pennsylvania Department of Aging (PDA) Waiver Program Handbook 02/28/97 35-97-03
36-97-03— Pennsylvania Department of Aging (PDA) Waiver Program Billing Instructions 02/28/97 23-97-03
28-97-03
29-97-03
33-97-03— Pennsylvania Department of Aging (PDA) Waiver Program Billing Instructions 02/28/97 01-97-03
05-97-02
18-97-02
19-97-04— Pennsylvania Department of Aging (PDA) Waiver Program Handbook 02/28/97 55-97-02 — Pennsylvania Department of Aging (PDA) Waiver Certification Process 02/28/97 23-97-02
28-97-02
29-97-02
33-97-02
35-97-02
36-97-02— Expansion of the Pennsylvania Department of Aging (PDA) Waiver 02/28/97 35-97-01
36-97-01Ch. 1121 Brand Name Drugs Prior Authorization Updated List 03/17/97 01-97-06
02-97-01
03-97-02
04-97-02
10-97-01
11-97-03
12-97-01
19-97-06
26-97-02
28-97-04
29-97-04
30-97-01
33-97-04
49-97-01Ch. 1121 Updates to State Maximum Allowable Cost (State MAC) List 03/21/97 01-97-04
19-97-05Ch. 1150
1141Discontinuance of the Mandatory Second Program (SOP) 03/25/97 01-97-05
03-97-01
04-97-01
06-97-01
08-97-01
11-97-02
12-97-02
26-97-01
1150-97-01Ch. 1101
1150Medical Assistance Program Fee Schedule Revision 1997 HCPCS Updates 04/10/97 05-97-03
19-97-07
23-97-04Ch. 1101
1150Medical Assistance Program Fee Schedule Revision 1997 HCPCS Updates 04/10/97 01-97-07
03-97-03
04-97-03
10-97-02
11-97-04
12-97-03
15-97-01
16-97-01
17-97-02
20-97-01
30-97-02
43-97-01
49-97-02
50-97-01Ch. 1221 Change in Billing Procedure for Emergency Room Visits 05/12/97 11-97-05
12-97-04
13-97-01Ch. 1141
1144
1241Diagnostic and Psychological Evaluations 05/28/97 01-97-08
17-97-03
41-97-01
48-97-01
49-97-03
50-97-02— Pennsylvania Department of Aging (PDA) Waiver Procedure Code Update 06/06/97 01-97-09
05-97-04
18-97-03
19-97-08
23-97-05
28-97-05
29-97-05
33-97-05— Coverage of COMVAX 06/11/97 01-97-10
10-97-03
11-97-06
17-97-04
19-97-09
26-97-03Ch. 1101
1150Provider Produced Invoices 06/11/97 99-97-03 — HealthChoices Phase 2 Extension of Enrollment Period 06/17/97 99-97-04 Ch. 1101
1150Changes to the Medical Assistance Program 1997 HCPCS Updates 06/30/97 01-97-11
03-97-04
04-97-04
10-97-04
11-97-07
12-97-05
15-97-02
16-97-02
17-97-05
20-97-02
30-97-03
43-97-02
49-97-04
50-97-04— InterQual Intensity/Severity/Discharge (ISD) Criteria for Review of Hospital Admissions 07/01/97 01-97-12
11-97-08
12-97-06
13-97-02Ch. 1241 Training for EPSDT Expanded Services (Provider Type 50) on Completing Medical Assistance Invoices 07/07/97 50-97-03 Ch. 1241 Revised Recommended Childhood Immunization Guidelines 07/23/97 1241-97-01
01-97-13
01-97-13
10-97-05
11-97-09
17-97-06
26-97-04
49-97-05Ch. 1141 Revision to Physician Assistance and Midwife Supervision Requirements 07/30/97 01-97-14
02-97-02
06-97-02
08-97-02
09-97-01
10-97-06
11-9711
12-97-07
25-97-01
26-97-05
30-97-04
31-97-01
37-97-01
38-97-01
1141-97-01Ch. 1121 Pharmacy Recordkeeping Requirements 08/04/97 19/97/10 — Revised Social Security Administration Definition of Disability for Children 08/08/97 99-97-05 Ch. 1163 Cost Outlier Payments for Certain Burn and Neonate Cases 08/11/97 11-97-10 — Reporting Procedures for Residents Targeted Under OBRA '87 and OBRA '90 08/29/97 34-97-01
35-97-04
36-97-04Ch. 1101
1150Accurate Billing for Units of Service Based on Periods of Time 09/17/97 99-97-06 Ch. 1121 Updates to State Maximum Allowable Cost (State MAC) List 09/17/97 01-97-15
19-97-11— The Addition of Viracept to the Special Pharmaceutical Benefits Program Formulary 11/10/97 01-97-18
02-97-03
11-97-12
19-97-13
23-97-06
26-97-06
28-97-07
30-97-05
35-97-05
36-97-05
37-97-02
45-97-01
46-97-01— Amendment to Medical Assistance Bulletin # 99-96-08 11/20/97 99-96-11 Ch. 1121 Updates to State Maximum Allowable Cost (State MAC) List 11/21/97 01-97-17
19-97-12— Amendment to Medical Assistance Bulletin # 99-96-08 11/27/97 99-96-09 Ch. 1101
1150Billing Instructions for Medicare Part B Claims 11/27/97 99-96-10 Ch. 1147 Revisions to the HealthCare Benefits Packages Reference Chart (MA 446) 12/18/97 99-97-07 — HealthChoices Southwest Mandatory Managed Care Program Implementation Schedule 12/19/97 99-97-08 1998 Ch. 1141 Physician Services Handbook Replacement Pages 01/20/98 01-98-01 Ch.1150 Clarification of Procedures for Requesting Copies of Medical Assistance Recipients' Bills 02/27/98 99-98-01 Training for Nursing Facilities on Completing Medical Assistance Invoices 03/03/98 35-98-02
36-98-02— Medical Assistance (Medicaid) Financial Eligibility Application for Long Term Care, Supports and Services (PA 600L) 03/03/98 11-98-01
12-98-01
14-98-01
24-98-01
25-98-01
34-98-01
35-98-01
36-98-01
51-98-01
53-98-01
55-98-01
56-98-01— Second Expansion of the Pennsylvania Department of Aging PDA Waiver 03/13/98 01-98-03
05-98-02
18-98-02
19-98-02
55-98-03— Pennsylvania Department of Aging (PDA) Waiver Program Billing Instructions (2nd Expansion) 03/13/98 01-98-02
05-98-01
18-98-01
19-98-01— Second Expansion of the Pennsylvania Department of Aging (PDA) Waiver 03/13/98 35-98-05
36-98-05— Pennsylvania Department of Aging (PDA) Waiver Program Billing Instructions (2nd Expansion) 03/13/98 55-98-02 — Pennsylvania Department of Aging (PDA) Waiver Certification Process (2nd Expansion 03/13/98 23-98-02
28-98-02
29-98-01
33-98-01
35-98-03
36-98-03— Pennsylvania Department of Aging (PDA) Waiver Program Billing Instructions (2nd Expansion) 03/13/98 35-98-04
36-98-04— Pennsylvania Department of Aging (PDA) Waiver Program Billing Instructions (2nd Expansion) 03/13/98 23-98-03
28-98-03
29-98-02
33-98-02— Second Expansion of the Pennsylvania Department of Aging (PDA) Waiver 03/13/98 23-98-04
28-98-04
29-98-03
33-98-03Ch. 1101
1150Announcement of Revised Millennium Medical Assistance Claims Forms 03/16/98 99-98-02 Ch. 1101
1150Medical Assistance Program Fee Schedule Revision 1998 HCPCS Updates 03/25/98 05-98-03
04/06/98 01-98-04
03-98-01
04-98-01
10-98-01
11-98-02
12-98-02
15-98-01
16-98-01
17-98-01
20-98-01
30-98-01
43-98-01
49-98-01
50-98-01Ch. 1101
1150Revisions to and Instructions for Completing & Submitting Revised ''Millennium'' Medical Assistance (MA) Claim Forms 04/22/98 99-98-04 — Clarification of the HealthChoices Recipient Coverage Policy for Behavioral Health Services 04/30/97 01-98-05
17-98-02
41-98-01
48-98-01
49-98-02
50-98-02
53-98-02
80-98-01— Medical Assistance Surety Bonds Interim Procedures 05/01/97 23-98-06 Ch. 1163 Revision of Utilization Guidelines for Inpatient Hospital Drug and Alcohol Services under the Medical Assistance Program 05/18/98 01-98-06
11-98-03
12-98-03
17-98-03
1163-98-01— Revised Case-Mix Reimbursement System Cost Report (MA-11) 05/20/98 35-98-07 — Revised Medical and Treatment Self—Directive Statement 06/19/98 11-98-04
12-98-04
13-98-02
14-98-02
17-98-04
23-98-07
34-98-02
35-98-08
36-98-08
37-98-01
38-98-01
53-98-03Ch. 1101
Ch. 1141
Ch. 1150
Ch. 1221Regulation Changes Regarding ''Emergency Medical Condition'' 07/01/98 1101-98-01
1141-98-01
1150-98-01
1121-98-01Medical Assistance Tele-Response System 07/01/98 99-98-05 — The Addition of Viramune and Rescriptor to the Special Pharmaceutical Benefits Program Formulary 07/01/98 01-98-08
02-98-01
11-98-05
19-98-05
23-98-08
26-98-01
28-98-05
30-98-02
35-98-09
36-98-09
37-98-02
45-98-01
46-98-01Ch. 1150
1241Increase in the Fees for the Administration of Vaccines 07/01/98 01-98-09
10-98-02
11-98-06
12-98-05
49-98-03Ch. 1121 Updates to State Maximum Allowable Cost (State MAC) List 07/06/98 01-98-07
19-98-04— Preparation of Statements of Claim for Recipients Enrolled in Managed Care 07/07/98 99-98-07
258-98-01Ch. 1150 Implementation of ''Millennium'' Claims Submission 07/10/98 99-98-08 — Change in Billing Procedure for Behavioral Health Rehabilitation Services 07/10/98 01-98-10
41-98-02
48-98-02
49-98-04
50-98-03Ch. 1101 Revisions to the HealthCare Benefits Packages Reference Chart (MA 446) 07/17/98 99-98-09 Ch. 1123 Nebulizer Codes 07/24/98 01-98-11
05-98-04
10-98-03
11-98-07
12-98-06
19-98-06
23-98-09Ch. 1121 Updates to State Maximum Allowable (State MAC) List 08/14/98 01-98-12
19-98-07Ch. 1121 Brand Name Drugs Prior Authorization Updated List 08/24/98 01-98-13
02-98-02
03-98-02
04-98-02
10-98-04
11-98-08
12-98-07
19-98-08
26-98-02
28-98-07
29-98-04
30-98-03
33-98-04
49-98-05— InterQual Intensity/Sensitivity Discharge (ISD) Criteria for Review of Hospital Admissions 08/24/98 01-98-14
11-98-09
12-98-08
13-98-03— The Office of Social Program's (OSP)/Independence Waiver 09/11/98 99-98-10 — Billing Instructions for the Community Services Program for Persons with Physical Disability Waivers 09/11/98 51-98-01 Ch. 1150 Revised Billing Instructions for Medicare Part B Claims that Do Not Cross Over to Medical Assistance 09/14/98 99-98-11 Ch. 1150 Medical Assistance Program Fee Schedule Revision 1998 HCPCS Updates 09/21/98 07-98-01 Ch. 1150 Revision to Attachment Type Codes on Invoice Submissions 10/14/98 24-98-03
25-98-03
34-98-04
35-98-12
36-98-12— Change in Medical Assistance (MA) Bulletin Mailing Procedure 10/14/98 01-98-15
03-98-03
04-98-03
07-98-02
15-98-02
31-98-01
41-98-03
44-98-01
49-98-06— Statewide Expansion of the Pennsylvania Department of Aging (PDA) Waiver 11/17/98 10-98-05
11-98-10
12-98-09
13-98-04
14-98-03
17-98-05
20-98-02
23-98-10
26-98-03
28-98-08
29-98-05
33-98-05
37-98-03
41-98-04
43-98-02
45-98-02
46-98-02
48-98-03
49-98-07
51-98-03— Statewide Expansion of the Pennsylvania Department of Aging (PDA) Waiver 11/17/98 01-98-16
05-98-05
18-98-03
19-98-09
55-98-04— Statewide Expansion of the Pennsylvania Department of Aging (PDA) Waiver 11/17/98 35-98-13
36-98-13— Pennsylvania Department of Aging (PDA) Waiver Certification Process (Statewide Expansion) 11/17/98 10-98-06
11-98-11
12-98-10
13-98-05
14-98-04
17-98-06
20-98-03
23-98-11
26-98-04
23-98-09
29-98-06
33-98-06
35-98-14
36-98-14
37-98-04
41-98-05
43-98-03
45-98-03
46-98-03
48-98-04— Accurate Billing for Units of Service Based on Periods of Time 11/17/98 99-98-12 Ch. 1243 Clinical Laboratory Improvements Amendments (CLIA) Requirements 11/25/98 01-98-17
11-98-12
16-98-02
17-98-07— Pennsylvania Department of Aging (PDA) Waiver Program Billing Instructions (Statewide Expansion) 12/22/98 35-98-15
36-98-15— Pennsylvania Department of Aging (PDA) Waiver Program Billing Instructions (Statewide Expansion) 12/22/98 01-98-18
05-98-06
18-98-04
19-98-10— Pennsylvania Department of Aging (PDA) Waiver Program Billing Instructions (Statewide Expansion) 12/22/98 10-98-07
11-98-13
12-98-11
13-98-06
14-98-05
17-98-08
20-98-04
23-98-12
26-98-05
28-98-10
29-98-07
33-98-07
37-98-05
41-98-06
43-98-04
45-98-04
46-98-04
48-98-05
49-98-09
51-98-05— Pennsylvania Department of Aging (PDA) Waiver Program Billing Instructions (Statewide Expansion) 12/22/98 55-98-05 Ch. 1141
Ch. 1153Clozapine Support Services 12/29/98 33-98-08
29-98-08
01-98-19Procedure for Requesting Prior Authorization of Medical Assistance Case Management Services for Recipients Under the Age of 21 12/31/98 05-98-04 1999 Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for which Registration has been denied or approval withdrawn 01/01/99 88-99-01 — Address Change for Provider Inquiry 01/27/99 99-99-01 — Medicheck List (1) Providers, Entities and Individuals Precluded from Participation in The Medical Assistance Program (2) Shared Health Facilities for which Registration has Been Denied or Approval Withdrawn 02/01/99 88-99-02 — Change in Procedure for Billing Administration of DT and Td Vaccines 02/09/99 01-99-02
10-99-01
11-99-02
26-99-02
49-99-01Ch. 1140 New Procedure Code for Healthy Beginnings Plus Program 02/12/99 01-99-01
11-99-01
23-99-01
26-99-01
30-99-01
31-99-01— Continued Existence of the Fee-For-Service (FFS) Delivery System in the HealthChoices Zones and Use of HealthChoices Zones and Use of Access Cards 02/12/99 99-99-03 — The addition of Sustiva (efavirenz) and Ziagen (abacavir) to the Special Pharmaceutical Benefits Program Formulary 02/15/99 01-99-03
02-99-01
11-99-03
19-99-01
23-99-02
26-99-03
28-99-01
30-99-02
35-99-01
36-99-01
37-99-01
45-99-01
46-99-01Ch. 1101
1150Medical Assistance Program Fee Schedule Revision 1999 HCPCS updates 02/26/99 99-99-02 — Medicheck List (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 03/01/99 88-99-03 Ch. 1225 Price Increase and Additional Services for Family Planning Clinics 03/04/99 34-99-01
35-99-02
36-99-02Ch. 1221 Change in Podiatric Billing Procedure for Emergency Room Visits 03/22/99 04-99-01 — Medicheck List (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 04/01/99 88-99-04 Ch. 1101 Revised HealthCare Benefits Packages Reference Chart 04/20/99 99-99-04 Medicheck List (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 05/01/99 88-99-05 — Severity Two Hour Supply HealthChoices Southeast 05/28/99 19-99-02 — Medicheck List (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 06/01/99 88-99-06 Capital Component Payments for Post Moratorium Beds 06/28/99 35-99-05
36-99-05
1187-99-01— Medicheck List (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 07/01/99 88-99-07 Ch. 1121 Prescriptions NOT received by the Medical Assistance (MA) Recipient 07/05/99 19-99-04 Ch. 1149 Increased Fees for Selected Pediatric Dental Services 07/09/99 33-99-01 — The Addition of Agenerase (amprenavir) To the Special Pharmaceutical Benefits Program Formulary 07/09/99 01-99-04
02-99-02
11-99-04
19-99-03
23-99-03
26-99-04
28-99-04
30-99-03
35-99-03
36-99-03
37-99-02
45-99-02
46-99-02Ch. 1121 Updates to State Maximum Allowable Cost (State MAC) 07/16/99 01-99-05
19-99-05— Millennium Compliance 07/27/99 99-99-05 Ch. 1150
1163Training for Inpatient Facilities on Completing the UB-92 Invoice 07/27/99 11-99-06
12-99-02
13-99-01
53-99-01— Medicheck List (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 08/01/99 88-99-08 — Additions and Corrections of Fee Increases for Specific Services Rendered by Outpatient Psychiatric clinics, Psychiatric partial Hospitalization Programs, and Outpatient Drug and Alcohol clinics 08/30/99 28-99-05
29-99-03
33-99-02Ch. 1150
1241Clarification of Enrollment and Billing Procedures for Physical, Speech, and Occupational Therapy 08/30/99 43-99-01
50-99-01— Medicheck List (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 09/01/99 88-99-09 Ch. 1101 ''Payment in Full'' 09/17/99 99-99-06 Medicheck List (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 10/01/99 88-99-10 Ch. 1145 Change in Recipient Access to Chiropractic Services in the Managed Care Delivery System 10/22/99 99-99-07 — Medicheck List (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 11/01/99 88-99-11 Ch. 1147 Medical Assistance (MA) Payment Policy for Eyeglasses Coverage 11/05/99 01-99-06
05-99-01
15-99-01Ch. 1121 Prior Authorization of Viagra and Other Drugs for Erectile Dysfunction Treatment Criteria, Limits and Procedures 11/22/99 99-99-08 Ch. 1225 Price Increase and Additional Services for Family Planning Clinics 11/22/99 30-99-04 Ch. 1121 Fee Increase for the ParaGuard IUD 11/22/99 01-99-07
10-99-02
11-99-07Medicheck List (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 12/01/99 88-99-12 Ch. 1241 Coverage of Medically Necessary Services and Equipment for Children in Early Intervention or Special Education Programs 12/03/99 01-99-08
05-99-02
11-99-08
17-99-01
23-99-04
43-99-02
50-99-02Ch. 1241 Clarification of Enrollment and Billing Procedures for EPSDT Expanded Services Providers of Physical Therapy, Speech Therapy and Occupational Therapy 12/10/99 50-99-04 Ch. 1121 Prescription Refills Maintenance Medications 12/10/99 19-99-06 Ch. 1142 Expanded Procedures Codes for Provider Type 31 Midwives2000 Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 12/29/99
—
01/01/0031-99-02
88-00-01— Expansion of Special Pharmaceutical Benefits Clozaril Program 01/28/00 01-00-01
02-00-01
05-00-01
11-00-01
13-00-01
14-00-01
19-00-01
23-00-01
26-00-01
29-00-01
33-00-01
35-00-01
36-00-01
49-00-01— Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 02/01/00 88-00-02 — Revised Billing Instructions for the Community Services Program for Persons with Physical Disabilities (CSPPPD) Waivers 02/15/00 51-00-01 — Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 03/01/00 88-00-03 — Changes in Terminology in Medical Assistance Program Fee Schedule for Type of Service/Procedure Code AG/W1855 03/13/00 28-00-01 Ch. 1121 Updated State Maximum Allowable Cost (MAC) List 03/17/00 01-00-02
19-00-02— Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 04/01/00 88-00-04 — Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 05/01/00 88-00-05 — Continued Existence of the Fee-for-Service (FFS) Delivery System in HealthChoices Zones and Use of ACCESS Cards 05/24/00 99-00-01 Ch. 1121 Prior Authorization List of Brand Name Drugs 05/25/00 01-00-04
02-00-02
03-00-01
04-00-01
10-00-01
11-00-02
12-00-01
19-00-05
26-00-02
28-00-02
29-00-02
30-00-01
33-00-01
49-00-02Ch. 1121 Updated State Maximum Allowable Cost (MAC) List 05/26/00 01-00-03
19-00-04— Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 06/01/00 88-00-06 Ch. 1141 Elimination of Physician Attestation Requirement 06/22/00 01-00-05 11-00-03 — Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 07/01/00 88-00-07 Ch. 1251 Increased Fees for Funeral Director Services 07/03/00 22-00-01 — Implementation of the Medical Assistance Programs' Internet website www.dpw.state.pa.us/omap 07/07/00 99-00-02 Ch. 1145 Change in Recipient Access to Chiropractic Services in the Managed Care Delivery System 07/12/00 99-00-03 Ch. 1121 Updated State Maximum Allowable Cost (MAC) List 07/19/00 01-00-06
19-00-06— Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 08/01/00 88-00-08 Ch. 1121 Clarification of Billing Instructions for Methadone Maintenance Services 08/21/00 28-00-03 — Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 09/01/00 88-00-09 Ch. 1141
1163Increased Fees for Selected Neonatal Intensive Care Procedure Codes and the Addition of a New Neonatal Intensive Care Procedure Code 09/01/00 01-00-07 — Prior Authorization Interim Supply of Medication HealthChoices Southwest (Revised) 09/07/00 19-00-07 — Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 10/01/00 88-00-10 Ch. 1150 Clarification of the 1150 Administrative Waiver Process also known as the Program Exception Process for Prosthetic and Orthotic Providers 10/04/00 01-00-08
05-00-02
19-00-08— Application for Health Care Coverage 10/13/00 99-00-04 — Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 11/01/00 88-00-11 Ch. 1241 Pennsylvania Vaccines for Children (VFC) Program 11/15/00 01-00-10
10-00-03
11-00-05
26-00-04— HealthCare Benefits Package 12 Updated Employability Assessment Procedure Code List 11/15/00 01-00-09
10-00-02
11-00-04
12-00-02
15-00-01
16-00-01
20-00-01
26-00-03
28-00-04
29-00-03
49-00-03Ch. 1243 Change in Payment Amount and Payment Method for the HIV-1 Viral Load Test (CPT Code 87536) 11/17/00 11-00-06
12-00-03
16-00-02— The Addition of Kaletra (lopinavir/ritonavir) to the Special Pharmaceutical Benefits Program Formulary 11/21/00 01-00-11
02-00-03
11-00-07
19-00-09
23-00-02
26-00-05
28-00-05
30-00-02
35-00-02
36-00-02
37-00-01
45-00-01
46-00-01— Consent Forms for the Release of Confidential Information 11/28/00 99-00-05 — Revised Target Resident Reporting Form (MA 408)* 11/28/00 34-00-02
35-00-05
36-00-04Ch. 1141 Medical Assistance (MA) Payment Policy for Multivisceral Transplants 11/28/00 01-00-12
11-00-08
17-00-02Ch. 1221 Voluntary Managed Care Organization's Payment Responsibility for Emergency Room Services 11/28/00 17-00-03 — Admissions Notice Packet (MA 401) 11/28/00 24-00-01
25-00-01
34-00-01
35-00-03
36-00-01— Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 12/01/00 88-00-12 — Revised Billing Instructions: Specified Medical Assistance (MA) Services in MA Voluntary Managed Care 12/08/00 01-00-14
03-00-02
04-00-02
05-00-03
08-00-01
10-00-04
11-00-09
12-00-04
16-00-03
17-00-04
20-00-02
23-00-03
31-00-01
40-00-01
41-00-02
44-00-01
45-00-02
49-00-05
50-00-03Ch. 1121 Updated State Maximum Allowable Cost (MAC) List 12/11/00 01-00-15
19-00-10Ch. 1101
1150Medical Assistance Program Fee Schedule Revision 1999/2000 HCPCS Updates 12/22/00 99-00-06 — Freedom of Choice for Medical Assistance Recipients Requiring Behavioral Health Services 12/29/00 01-00-16
29-00-05
33-00-04
41-00-03
48-00-02
49-00-06
50-00-04Ch. 1149 Dental Fee Increase and Medical Assistance Program Fee Schedule Revisions 12/29/00 03-00-03 — Prior Authorization of Therapeutic Staff Support (TSS) Services 12/29/00 01-00-13
29-00-04
33-00-03
41-00-01
48-00-01
49-00-04
50-00-022001 — Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 01/01/01 88-01-01 Ch. 1121 Diabetes Outpatient Self-Management Training and Education 01/15/01 99-01-01 Ch. 1121 List of Brand Name Drugs Requiring Prior Authorization 01/30/01 01-01-01
02-01-01
03-01-01
04-01-01
10-01-01
11-01-01
12-01-01
19-01-01
26-01-01
28-01-01
29-01-01
30-01-01
33-01-01
49-01-01Ch. 1101
1150Delete Procedure Codes with Type of Service 35 from the Medical Assistance Program Fee Schedule 02/01/01 10-01-02
11-01-02
26-01-02Ch. 1149 Issuance of a Replacement Page to the January 1, 2001 Medical Assistance Program Fee Schedule for Dental Services 02/01/01 03-01-02 — Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 02/01/01 88-01-02 Ch. 1101
1223Clarification of Coverage for Motorized Wheelchairs and Other Durable Medical Equipment 02/16/01 01-01-02
05-01-01
17-01-01
19-01-02
49-01-02
50-01-01
1101-01-01
1123-01-01Ch. 1149 Addition of Selected Periodontal Services to the Medical Assistance Program Fee Schedule 02/28/01 03-01-03 — Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 03/01/01 88-01-03 — Expanded Hours of Operation for the Provider Services Toll-Free Inquiry Lines 03/28/01 99-01-02 — Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 04/01/01 88-01-04 Ch. 1150
1141Medical Assistance (MA) Payment Policy for Multivisceral Transplants 04/06/01 01-01-03
11-01-03
17-01-02— Behavioral Specialist Consultant and Mobile Therapist 04/26/01 01-01-04
17-01-03
29-01-02
33-01-02
41-01-01
48-01-01
49-01-03
50-01-02Ch. 1149 Implementation of the ADA Claim Form—Version 2000 and Revised Billing Instructions for Assistant Surgeons 04/27/01 03-01-04 Ch. 1101
1150Medical Assistance Program Fee Schedule Revision 2001 HCPCS Updates 04/27/01 99-01-03 — Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 05/01/01 88-01-05 — Automated Clearinghouse (ACH)—Electronic Funds Transfer 05/04/01 99-01-04 — Consent Forms for the Release of Confidential Information 05/18/01 99-01-05 — Additional Place-of-Service (Office) for Psychotherapy 06-01-01 01-01-09
41-01-06— Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 06/01/01 88-01-06 — Revisions to Policies and Procedures Relating to Mobile Therapy, Behavioral Specialist Consultant and Therapeutic Staff Support Services 06/01/01 01-01-05
29-01-03
33-01-03
41-01-02
48-01-02
49-01-04
50-01-03— Section V—Billing Information Nursing Facility Services Handbook 06/04/01 35-01-01
36-01-01Ch. 1142 Reissue Expanded Procedure Codes for Independent Certified Nurse Midwives 06/15/01 01-01-08
31-01-01— Addition of Behavioral Health Rehabilitation Service to the Medical Assistance (MA) Program Fee Schedule 06/21/01 01-01-07
29-01-05
33-01-05
41-01-04
48-01-04
49-01-06
50-01-05Office of Medical Assistance Programs (OMAP) Fraud and Abuse Hotline 06/27/01 99-01-06 Ch. 1243 Training for Outpatient Laboratories on Completing the MA 319 and HCFA 1500 Invoices 06/29/01
11-01-04 16-01-01 Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 07/01/01 88-01-07 Ch. 1241 Revision to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program 07/01/01 01-01-10
10-01-03
11-01-05
17-01-04
26-01-03
49-01-07Ch. 1121 Medicaid Drug Rebate Program Participating Drug Labelers Updated List 07/12/01 01-01-11
02-01-02
03-01-05
04-01-02
10-01-04
11-01-06
12-01-02
19-01-03
26-01-04
28-01-02
29-01-06
30-01-02
33-01-06
49-01-08— Long Term Care Toll Free Inquiry Lines 07/16/01 24-01-01
25-01-01
34-01-01
35-01-02
36-01-02— The Use of Restraint and Seclusion in Psychiatric Residential Treatment Facilities (RTF) 07/23/01 53-01-01 Ch. 1145 Recipient Access to Chiropractic Services in the Managed Care Delivery System 07/31/01 99-01-07 — Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 08/01/01 88-01-08 Ch. 1121 Updated State Maximum Allowable Cost (MAC) List 08/09/01 01-01-12
19-01-04— Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 09/01/01 88-01-09 Ch. 1101 Revised HealthCare Benefits Packages Reference Chart 09-10-01 99-01-08 Ch. 1121 ON-LINE Pharmacy Extended Reversal Implementation 09/11/01 19-01-05 — Billing for Clozaril and Clozapine in the Voluntary HMOs 09/25/01 01-01-14
19-01-06— Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 10/01/01 88-01-10 — The Addition of Geodon Iziprasidone to the Special Pharmaceutical Benefits Program Formulary for Atypical Antipsychotic Medications 10/25/01 01-01-15
02-01-03
05-01-02
11-01-08
13-01-01
14-01-02
19-01-07
23-01-01
26-01-06
27-01-01
29-01-08
32-01-01
33-01-07
35-01-03
36-01-03
49-01-10— Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 11/01/01 88-01-11 — Medicheck List: (1) Providers, Entities and Individuals Precluded from Participation in the Medical Assistance Program (2) Shared Health Facilities for Which Registration has been Denied or Approval Withdrawn 12/01/01 88-01-12 — The Addition of Viread (tenofir Disoproxil fumarate) to the Special Pharmaceutical Benefits Program Formulary 12/07/01 01-01-16
02-01-04
11-01-09
19-01-08
23-01-02
26-01-07
28-01-04
30-01-03
35-01-04
36-01-04
37-01-01
45-01-01
46-01-01Ch. 1149 Revision to Medical Assistance Dental Services 12/19/01 03-01-06 — MCO-FFS Split Billing for Inpatient Services 12/20/01 11-01-10
12-01-04
17-01-05— Medical Assistance for Workers with Disabilities (MAWD) 12/21/01 99-01-11 Ch. 1121 Prior Authorization of Sustained/Controlled Release Oxycodone/OxyContin 12/11/01 99-01-10 — Breast and Cervical Cancer Prevention and Treatment Program 12/26/01 99-01-12 Ch. 1249 Discontinuance of Prior Authorization Requirement for Home Health Postpartum Visits 12/27/01 01-01-19
11-01-11
23-01-03Ch. 1150 Ordering Medical Assistance Forms and Invoices 12/27/01 99-01-09 Ch. 1141
1150Increased Reimbursement for Anesthesia Procedure 12/27/01 01-01-14
44-01-01— Billing for Protease Inhibitors for HealthChoices Southeast MCOs 12/27/01 01-01-18
19-01-19Ch. 1123 Coverage of Enteral Nutritional Supplements 12/28/01 99-01-13 2002 — Discontinuance of Hard Copies of Medicheck List 01/01/02 88-02-01 Ch. 1121 Discontinuance Prior Authorization of Proton Pump Inhibitors and Prostaglandins 01/03/02 99-02-01 Ch. 1249 Revisions to the Home Health Agency Enrollment Process 01/04/02 23-02-01 Ch. 1121 Coverage of Tobacco Cessation Drug Products and Counseling Services 01/16/02 99-02-02 Ch. 1241 Revision to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program 01/22/02 01-02-01
10-02-01
11-02-01
17-02-01
26-02-01
49-02-01Ch. 1121 Updated State Maximum Allowable Cost (MAC) List 01/28/02 01-02-02
19-02-01Ch. 1121 List of Brand Name Drugs Requiring Prior Authorization 01/30/02 01-02-03
02-02-01
03-02-01
04-02-01
10-02-02
11-02-02
12-02-01
19-02-02
26-02-02
28-02-01
29-02-01
30-02-01
33-02-01
49-02-02— The Michael Dallas Waiver 01/30/02 99-02-03 Ch. 1221 Diabetes Outpatient Self-Management Training and Education 02/06/02 99-02-04 Ch. 1130 BPI Retrospective Review of Hospice Services 02/21/02 01-02-04
17-02-02
37-02-01— Electronic Submission of the Cost Report (MA-11) Form for Reporting Periods Ending 12/21/2011 and Thereafter 02/21/02 35-02-01
36-02-01— Reissue of Medical Assistance (MA) Bulletin Addition of Behavioral Health Rehabilitation Service to the MA Program Fee Schedule 03/06/02 01-02-05
29-02-02
33-02-02
41-02-01
48-02-01
49-02-03
50-02-01— Urgent Care Transportation Requests through the Medical Assistance Transportation Program (MATP) 03/14/02 99-02-05 — Stopping Accidental Falls in Elders (SAFE) 03/21/02 01-02-06
11-02-03
12-02-02
13-02-41
14-02-01
35-02-02
36-02-02— Documentation and Medical Record Keeping Requirements 03/21/02 29-02-03
33-02-03
41-02-02— Medical Assistance Estate Recovery Program Brochure 04/03/22 34-02-01
35-02-03
36-02-03— Reminder to Providers Who Prescribe Behavioral Health Rehabilitation Services of Documentation Requirements 04/03/02 01-02-07
29-02-04
33-02-04
41-02-03
48-02-02
50-02-02
09-02-04Ch. 1123 Exceptional Durable Medical Equipment (DME) 04/04/02 01-02-08
05-02-01
17-02-03
19-02-03
35-02-04
36-02-04— Breast and Cervical Cancer Prevention and Treatment Program 05/03/02 99-02-06 — Clarification and Update to Bulletin 36-91-01 Regarding Invoice Exception Process for Long Term Care Facilities 05/21/02 25-02-01
35-02-05
36-02-05— Performance Expectations and Recommended Guidelines for the County Child and Adolescent Services System Program (CASSP) 06/06/02 OMHSAS-02-02 — Health Insurance Portability & Accountability Act (HIPAA) 06/25/02 99-02-07 — Electronic Provider Enrollment Automation Program (ePEAP) 07/18/02 99-02-08 — Section VII—Utilization Management Review Nursing Facility Services Handbook 07/18/02 35-02-06
36-02-06Ch. 1101 Revision to the HealthCare Benefits Packages Reference Chart (MA 446) 07/18/02 99-02-09 Ch. 1145 Change in Recipient Access to Chiropractic Services in the Managed Care Delivery System 08/12/02 99-02-10 — Residential Treatment facility Services Provided in a Secure Setting 10/01/02 01-02-11
11-02-04
12-02-03
13-02-02
17-02-04
41-02-04
50-02-03
53-02-01— Prior Authorization Interim Supply of Medication HealthChoices Lehigh/Capital Region 10/10/02 19-02-06 — Community Care (COMMCARE) Waiver Provider
Type 5910/16/02 05-02-04
17-02-05
19-02-07
23-02-02
28-02-03
29-02-05
38-02-01
39-02-01
41-02-05
43-02-01
51-02-01
55-02-01
56-02-01
59-02-01— Outpatient Drug and Alcohol Clinics with Provisional Licenses 10/16/02 28-02-02 Ch. 1241 Addition of Procedure Code 90732 to Medical Assistance Fee Schedule for Administration of Pneumococcal Vaccine 11/18/02 01-02-13
10-02-04
11-02-06
17-02-07
26-02-04
49-02-06Ch. 1241 2002 Recommended Childhood Immunizations Schedule 11/18/02 01-02-12
10-02-03
11-02-05 17-02-06
26-02-03
49-02-05— Continued Existence of the Fee-for-Service (FFS) Delivery System in HealthChoices Zones and Use of ACCESS Cards 11/27/02 99-02-11 Ch. 1101
1150Medical Assistance Program Fee Schedule Revisions: HIPAA Compliant Procedure Codes 11/27/02 99-02-12 Ch. 1121 Misrepresentation of Prescriber on the Drug Claim 11/27/02 19-02-08 Ch. 1101 The Bureau of Program Integrity and the Medical Assistance Provider Self-Audit Protocol 12/02/02 99-02-13 — Home Health Agency Services Fee Increase and Medical Assistance Program Fee Schedule Revisions 12/20/02 23-02-03 — Prior Authorization Update for Interim Supply of Medication HealthChoices Southeast Region 12/27/02 19-02-09 2003 — Additional Place of Service (Office) For Psychotherapy 01/06/03 01-03-01
41-03-01Ch. 1149 Elimination of the Use of the Dental Service Invoice (MA 300D) and Providing Training on Completion of The ADA Claim Form (Version 2000) 01/08/03 03-03-01 Ch. 1147 Expanded Procedure Codes for Provider Type 15 Optometrist 01/13/03 15-03-01 Ch. 1101 Revised Healthcare Benefit Packages Reference Chart 01/13/03 99-03-02 — Availability of Training for Completion of Provider Behavioral Health Rehabilitation Services Reports 01/31/03 01-03-02
29-03-01
33-03-01
41-03-02
48-03-01
49-03-01
50-03-01Ch. 1121 Updated State Maximum Allowable Cost (MAC) List 03/03/03 01-03-03
19-03-01— Introduction of the HIPAA Ready Provider Electronic Solutions Software and Statewide Training Seminars 03/11/03 99-03-03 Ch. 1241 2003 Recommended Childhood Immunization Schedule 03/31/03 01-03-04
10-03-01
11-03-01
17-03-01
26-03-01
49-03-02Ch. 1163 Billing Procedures for Change in Delivery Systems during a Hospital Stay and Subsequent Hospital Admission 04/04/03 11-03-02
12-03-01
13-03-01
17-03-02Ch. 1249 Revised Prior Authorization and Program Exception Pages for the Home Health Services Handbook 04/08/03 23-03-01 Ch. 1123 Information on Accredited Rehabilitation Facilities to be Used for Motorized Wheelchair Evaluation 04/14/03 01-03-05
05-03-02
19-03-03Ch. 1150 Elimination of the Use of the Medical Services Invoice 04/24/03 99-03-05 Ch. 1150 Medical Assistance Program Fee Schedule Revision 05/01/03 05-03-01
19-03-02Ch. 1150 Revisions to the Prior Authorization and Program Exception Notices 05/08/03 99-03-04 Ch. 1149 Medical Assistance Program Fee Schedule for Dental Services Revisions 05/12/03 03-03-02 Ch. 1144 Pharmaceutical Services Prescribed and/or Dispensed by a Certified Registered Nurse Practitioner (CRNP) 05/12/03 99-03-06 Ch. 1241 Coverage of Pediarix and Addition of Procedure Code 90723 to Medical Assistance Fee Schedule for Administration of Pediarix Vaccine 05/15/03 01-03-06
10-03-02
11-03-03
17-03-03
26-03-02
49-03-03— Process to Handle Residential Treatment Facility (RTF) Reports of Death, Serious Injury or Attempted Suicide (Serious Occurrences) 06/13/03 53-03-01 — Change of Protocol for Certain Provider Appeals. Appeals must be sent to Bureau of Hearings and Appeals 07/29/03 99-03-08 — Requirement for Medical Assistance (MA) Providers to Submit Accurate and Complete Encounter Data to MA Managed Care Organizations 08/01/03 99-03-10 — The Addition of Fuzeon (enfuvirtide) and Abilify (aripiprazole) to the Special Pharmaceutical Benefits Program 08/01/03 99-03-11 — Obligation of Medical Assistance Providers Participating in the Managed Care Delivery System to Comply with MA Regulations 08/01/03 99-03-09 Ch. 1149 Continuity of Care for Orthodontia Treatment—From Managed Care to Fee-For-Service 08/11/03 03-03-03 — Nursing Facility Responsibility to Notify HealthChoices and Voluntary Program MCOs of the Admission of an MCO Enrolled Member 08/27/03 35-03-02
36-03-02— Revisions to the Medical Evaluation Form 08/27/03 11-03-04
24-03-01
25-03-01
34-03-01
35-03-01
36-03-01Ch. 1101 Liability for Cost Sharing for Recipients Enrolled in Medical Assistance through Fee for Service or Managed Care and a Private Third Party Insurer 09/01/03 99-03-12 — Continuity of Care for Recipients Transferring Between and Among Fee for Service and Managed Care Organizations 09/01/03 99-03-13 Ch. 1121 Updated Maximum Allowable Cost (MAC) List 09/03/03 01-03-07
19-03-04
49-03-04Ch. 1241 Elimination of the Pennsylvania Children's Check-up (EPSDT) Form (MA-517) 09/05/03 01-03-08
10-03-03
11-03-05
17-03-04
26-03-03
49-03-05Ch. 1121 Medicaid Drug Rebate Program Participating Drug Labelers Updated List 10/01/03 01-03-09
02-03-02
03-03-04
04-03-01
10-03-03
11-03-06
12-03-02
19-03-05
26-03-04
28-03-01
29-03-02
30-03-01
33-03-02
49-03-06— Elimination of the Requirement for the Outpatient Drug and Alcohol Clinic's Supervisory Physician to Perform a Comprehensive Medical Examination Within 15 Days Following the Intake and Before the Provision of Treatment 10/01/03 28-03-02 Ch. 1101
1150Replacing and End-dating Local Procedure Codes 10/01/03 99-03-14 — The Addition of Reyataz (atazanavir sulfate) and Emtriva (emtricitabine) to the Special Pharmaceutical Benefits Program 10/15/03 99-03-16 — Special Pharmaceutical Benefits Program Time Sensitive Expansion Tiers Structure 10/17/03 99-03-19 — Changes to Electronic Claims Format 10/17/03 99-03-17 — Revisions to Medical Evaluation Form (MA 51) 10/17/03 01-03-10
11-03-07
24-03-02
25-03-02
34-03-02
35-03-03
36-03-03
99-03-17Ch. 1101
1150Medical Assistance Program Fee Schedule Revision 2002 HCPCS Updates 10/17/03 99-03-18 Ch. 1149 Supernumerary Tooth Enumeration and Quadrant Designation on the American Dental Association Claim Form (ADA Claim Form—Version 2000) 10/31/03 03-03-05 — Introduction to the Provider Reimbursement and Operations Management Information System (PROMISe) 10/31/03 99-03-20 — Clarification of Procedures for Requesting Copies of Medical Assistance Recipients' Bills 11/01/03 99-03-15 Ch. 1101
1150Medical Assistance Program Fee Schedule Revision 11/01/03 05-03-04
19-03-06— Health Insurance Portability and Accountability Act (HIPAA) Transaction and Code Sets Updates 12/01/03 99-03-21 — The Addition of Lexiva (fosamprenavir) to the Special Pharmaceutical Benefits Program 12/03/03 99-03-23 2005 Ch. 1101
1150Revisions to Prior Authorization of Drugs for Erectile Dysfunction 01/10/05 99-05-02 — Alternative Sanction Guidelines for ICF/MR Medical Assistance Certification 01/28/05 00-04-15 Ch. 1101
11502004 HCPCS Updates and Other Revisions to the Medical Assistance Fee Schedule 02/05/05 99-05-04 Ch. 1121 List of Brand Name Drugs Requiring Prior Authorization 02/10/05 01-05-01
08-05-01
09-05-02
11-05-01
14-05-01
21-05-01
24-05-02
27-05-01
31-02-02Ch. 1121 Updated State Maximum Allowable Cost (MAC) List 02/10/05 0905-01
24-05-01
31-05-01Ch. 1101 Change in Effective Date for Prior 1150 Authorization of Drugs That Exceed 1121 Established Quantity Limits and Brand Name Single Source Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) 04/26/05 99-05-09 — Implementation of the ACCESS Plus Program 05/23/05 99-05-11 Ch. 1241 2005 Recommended Childhood & Adolescents Immunization Schedule 05/26/05 33-05-01 — Integrated Children's Service Initiative 06/09/05 00-05-05 — Announcement of the National Provider Identifier Number 06/10/05 99-05-13 — Revised Maximum Participation Project Consent for Release of Information Form (PA 1723) 06/15/05 99-05-12 Ch. 1121 Non-Coverage of Drugs for the Treatment of Erectile Dysfunction for Sex Offenders 06/15/05 08-05-03
09-05-04
11-05-02
24-05-03
27-05-03
31-05-04Ch. 1101
1150Corrections to MA Bulletin 99-05-04: Addition of HCPCS Codes to Medical Assistance Programs Fee Schedule 06/20/05 99-05-10 — Psychological/Psychiatric/Clinical Re-Evaluations and Re-Authorizations or Behavioral Health Rehabilitation (BHR) Services for Children and Adolescents with Behavioral Health Needs Compounded by Developmental Disorders 06/24/05 07-05-01
08-05-04
09-05-05
11-05-03
19-05-01
31-05-05— Nursing Facility Assessments/Supplemental Payments 06/24/05 03-05-01 Ch. 1128 Clarification and Instructions for Providers Who Bill Medical Assistance for Dialysis Services When Medicare is the Primary Insurer 06/29/05 30-05-01 Ch. 1121 Revisions to Payment for the Drug Cost Component of Brand Name and Generic Drugs 08/05/05 09-05-06
24-05-06
25-05-01
31-05-06Ch. 1121 Prior Authorization of Drugs That Exceed Established Quantity Limits—Phase 1 Enforcement 08/10/05 99-05-14 Ch. 1121 Revisions to the State Maximum Allowable Cost for Pharmaceutical Services 08/18/05 09-05-07
24-05-07
25-05-02
31-05-07Ch. 1149 Dental Fee Increase for Anesthesia and Behavior Management Services 08/22/08 27-05-02 Ch. 1101 Copayment Changes for Brand Name and Generic Prescription Drugs 08/26/05 24-05-05 — Electronic Submission for the Cost Report (MA-11) Form for Reporting Periods Ending 06/30/2005 and Thereafter 08-26-05 03-05-02 Ch. 1101
1150Medical Assistance Program Fee Schedule Procedure Code Changes for Behavioral Health Services 09/08/05 08-05-05
09-05-08
11-05-04
16-05-01
17-05-01
19-05-02
21-05-02
31-05-08
34-05-01Ch. 1101
11502005 HCPCS Updates and Other Revisions to the Medical Assistance Fee Schedule; Prior Authorization Requirements 09/12/05 99-05-15 Ch. 1121 Prior Authorization of Drugs That Exceed Established Quantity Limits—Phase 2 Enforcement 09/16/05 99-05-17 Ch. 1249 Medical Assistance Program Fee Schedule Procedure Code Changes for Home Health Agency Services 09-16-05 05-05-01 Ch. 1121 Preferred Drug List 09/19/05 99-05-18 — $10,000 Lifetime Limit on Other Medical Expenses Related to Facility Services 09/20/05 03-05-03 — Long Term Care Resource Transfer Penalty 09/20/05 99-05-16 Ch. 1101 Medical Assistance Program Fee 1150 Schedule Procedure Code Changes for Healthy Beginnings Plus Program Services 09/23/05 01-05-03
05-05-02
08-05-06
31-05-09
33-0502
47-05-01Ch. 1101
1150Revised Outpatient Service Authorization Request Form (MA-97) 09/26/05 99-05-19 Ch. 1121 Preferred Drug List—Phase 1 10/07/05 02-05-01
03-05-04
08-05-08
09-05-10
11-05-05
14-05-02
24-05-08
27-05-04
30-05-02
31-05-11
32-05-02Ch. 1225 Medical Assistance Program Fee Schedule Procedure Code Changes for Family Planning Clinic Services 10/14/05 08-05-09 Ch. 1101
1150
1241Meningococcal Conjugate Vaccine Menactra (MCV4) 10/14/05 01-05-05
08-05-10
09-05-11
31-05-12
33-05-04Ch. 1241 Revisions to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Periodicity Schedule 10/25/05 01-05-04
08-05-07
09-05-09
31-05-10
33-05-03Ch. 1128 Medical Assistance Program Fee Schedule Procedure Code Changes for Renal Dialysis Services 10/27/05 30-05-03
31-05-13Ch. 1101 Medical Assistance Program Fee 1150 Schedule Procedure Code Changes for Case Management Services 10/27/05 21-05-03 Ch. 1225 Medical Assistance Program Fee Schedule Procedure Code Changes for Federally Qualified Health Centers and Rural Health Clinics 10/27/05 08-05-11 Ch. 1101
1150Medical Assistance Program Fee Schedule Procedure Code Changes for Medical Foster Care Services 10/27/05 40-05-01 Ch. 1243 Medical Assistance Program Fee Schedule Procedure Code Changes for Laboratory Services 11/01/05 01-05-06
28-05-01Ch. 125 Title XIX Medical Assistance Program Family Planning Clinic Fee Schedule 11/1/05 08-05-12 Ch. 1121 Tabs for the—Prior Authorization of Pharmaceutical Services—Handbook 11/4/05 02-05-02
03-05-05
08-05-13
09-05-12
11-05-06
14-05-03
24-05-09
27-05-05
30-05-04
31-05-14
32-05-03Ch. 1121 Preferred Drug List—Phase 2 11/08/05 02-05-03
03-05-06
08-05-14
09-05-13
11-05-07
14-05-04
24-05-10
27-05-06
30-05-05
31-05-15
32-05-03Ch. 1121 Scope of Coverage of Pharmacy Services for Dual Eligibles in the Medical Assistance (MA) Program 11/17/05 99-05-21 Ch. 1123 Addition of Prosthetic, Orthotic and Medical Supply Procedure Codes to the Medical Assistance Fee Schedule 11/21/05 24-05-11
25-05-03— Rescind MAB 40-05-02 and Reissue the Medical Assistance Program Fee Schedule Procedure Code Changes for Provider Mileage 11/22/05 31-05-16
27-05-07
14-05-05
15-05-01
18-05-01
05-05-03
08-05-15
33-05-05
09-05-14Ch. 1121 Preferred Drug List—Phase 3 12/01/05 02-05-04
03-05-07
08-05-16
09-05-15
11-05-08
14-05-06
24-05-12
27-05-06
30-05-06
31-05-06
32-05-04Ch. 1123 Medical Assistance Program Fee Schedule Procedure Code Changes for Durable Medical Equipment, Medical Supplies, Vision Supplies and Hearing Supplies 12/01/05 05-05-04
24-05-13
25-05-04Ch. 1101 Changes to the Program Exception 1150 Process as a Result of End-Dating Local Procedure Codes 12/01/05 99-05-22 Ch. 1144 Clarification of Enrollment Policy for CRNPs 12/16/05 09-05-16 Ch. 1121 Prior Authorization of Prilosec Over-the-Counter (OTC) and Loratadine OTC for Dual Eligibles 12/23/05 02-05-05
03-05-08
08-05-17
09-05-17
11-05-09
14-05-07
24-05-13
27-05-07
30-05-07
31-05-18
32-05-05Ch. 1241 Medical Assistance Program Fee Schedule Procedure Code Changes for Occupational Therapy Services 12/27/05 17-05-02 Ch. 1145 Medical Assistance Program Fee Schedule Procedure Code Changes for Chiropractic Services 12/27/05 15-05-02 Ch. 1121 Pen and Ink Change-Medical Assistance Handbook, Prior Authorization of Pharmaceutical Services, Preferred Drug List 12/30/05 02-05-06
03-05-09
08-05-18
09-05-18
11-05-10
14-05-08
24-05-04
27-05-08
30-05-08
31-05-19
32-05-062006 Ch. 1123 Fee Increase for Enteral Nutritional Supplements 12/29/06 24-06-15
25-06-02Ch. 1243 Medical Assistance Program Fee Schedule Additions of Four Laboratory Codes 12/27/06 01-06-15
08-06-21
28-06-01Ch. 1101
11502006 HCPCS Updates; Prior Authorization Requirements 12/19/06 99-06-17 Ch. 1101
1150Medical Assistance Program Fee Schedule Revision 12/19/06 99-06-18 — Implementation of the CMS-1500 Health Insurance Claim Form (Version 08/05) 12/18/06 99-06-16 Ch. 1241 Rotavirus Vaccine 12/15/06 01-06-14
08-06-20
09-06-19
31-06-26
33-06-07Ch. 1101 Change to copayment requirements for recipients eligible under the Breast and Cervical Cancer Prevention and Treatment coverage group and Titles IV-B & IV-E Foster Care and Adoption Assistance 12/10/06 99-06-12 Ch. 1101 Clarification of Exclusions from Copayment Requirements 12/10/06 99-06-13 Ch. 1121 Preferred Drug List—Quarterly Update 12/08/06 02-06-10
09-06-18
24-06-14
31-06-25
03-06-16
11-06-09
27-06-13
32-06-08
08-06-19
14-06-11
30-06-08— Mobile Mental Health Treatment 11/30/06 08-06-18 Ch. 1153 Clarification of Payment Policy for Abortion Services 11/28/06 99-06-15 — Instructions for Registering Your National Provider Identifier (NPI) Number to the Department of Public Welfare 11/22/06 99-06-14 Ch. 1245 Reimbursement for Non-Emergency Transportation Services 11/17/06 03-06-15 Ch. 1245 Implementation of ACCESS Plus Referral Requirements 10/20/06 99-06-11 — Medical Invoice UB-04 09/22/06 01-06-12
02-06-09
03-06-13Ch. 1241 Pennsylvania Vaccines for Children Program Update 09-22-06 01-06-11
08-06-17
09-06-17
31-06-23
33-06-06Ch. 1163 Medical Assistance Payment for Services of Teaching Physicians in Hospitals, Clinics and Emergency Rooms 09/16/06 1141-06-01
01-06-13
31-06-24Ch. 1121 Preferred Drug List—Quarterly Update 08/28/06 02-06-08
03-06-11
08-06-16
09-06-16
11-06-08
14-06-10
24-06-12
27-06-12
30-06-07
31-06-22
32-06-07— Revision to Minimum Staff Qualifications of Therapeutic Staff Support (TSS) Workers 08/24/06 08-06-15
09-06-15
11-06-07
19-06-04
31-06-21— The Addition of Atripla (efavirenz/emtricitabine/tenofovir) and Prezista (darunavir) to the Special Pharmaceutical Benefits Program 08/21/06 09-06-14
21-06-02
24-06-11
31-06-20Ch. 1121 Hepatitis A Vaccine 08/18/06 01-06-10
08-06-14
09-06-12
31-06-19
33-06-05Ch. 1241 Measles, Mumps, Rubella and Varicella (MMRV) Vaccine 08/10/06 01-06-09
08-06-13
09-06-11
31-06-18
33-06-04— Federal Medicaid Citizenship and Identity Eligibility Requirements for Medical Assistance Nursing Home Applicants or Recipients 07/28/06 03-06-10 Ch. 1101
1150
141Medical Assistance Program Fee Schedule Revisions for Medical and Radiological Procedure Codes 07/27/06 01-06-08
03-06-09
08-06-12
14-06-09
29-06-01
31-06-17Ch. 1153 Federal Medicaid Citizenship and Identity Eligibility Requirements 07/24/06 99-06-07 — Notification of Medicare Appeals Project and Billing Reminders for Home Health Services 07/20/06 05-06-01 Ch. 1101
1150Medical Assistance Program Fee Schedule Change 06/23/06 01-06-07
08-06-11
17-06-02
20-06-02
31-06-16Ch. 1163
1221Medical Assistance Program Fee Schedule Procedure Code Changes for Acute Care General Hospitals and Hospitals Based Medical Clinics 06/17/06 01-06-05 Ch. 1163
1221Medical Assistance Program Fee Schedule Procedure Code Changes for Medical Rehabilitation Units of General Hospitals and Rehabilitation Hospitals 06/17/06 01-06-06 Ch. 1101
1150Medical Assistance Program Fee Schedule Procedure Code Changes 06/17/06 99-06-06 Ch. 1123 Medical Assistance Program Fee Schedule Revision for Oxygen and Oxygen Equipment 06/06/06 24-06-10
25-06-01Ch. 1241 Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine 06/01/06 01-06-04
08-06-10
09-06-10
31-06-15
33-06-03Ch. 1121 Medicaid Drug Rebate Program Participating Drug Labelers Updated List 05/05/06 08-06-09
09-06-09
24-06-09
31-06-14Ch. 1123 Ventilator Dependent Respiratory (VDR) Program Preparing Table of Supply and Equipment Costs 04/28/06 03-06-08 Ch. 1121 Preferred Drug List—Quarterly Update 04/24/06 02-06-07
11-06-06
30-06-06
03-06-07
14-06-08
31-06-13
08-06-08
24-06-08
32-06-05
09-06-07
27-06-10Ch. 1121 Prior Authorization of Revatio 04/24/06 02-06-06
11-06-05
30-06-05
03-06-06
14-06-07
31-06-12
08-06-07
24-06-07
32-06-05
09-06-07
27-06-10Ch. 1150 Prudent Payment of Claims 04/20/06 99-06-04 Ch. 1241 2006 Recommended Childhood and Adolescent Immunization Schedule 04/16/06 01-06-03
08-06-06
09-06-05
31-06-11
33-06-02— Continued Existence of the Fee-for-Service (FFS) Delivery System in HealthChoices Zones and Use of ACCESS Cards 04/14/06 99-06-05 Ch. 1149 Elimination of Post-Operative Review of Endodontic Therapy for Individuals 21 Years of Age and Older 03/21/06 27-06-09 Ch. 1121 Prior Authorization of Botox, Synagis and Xolair 03/09/06 02-06-05
03-06-04
08-06-05
09-06-04
11-06-04
14-06-06
24-06-05
27-06-08
30-06-03
31-06-08
32-06-03— Special Pharmaceutical Benefits Program Revisions to Payment Methodology 03/07/06 19-06-03
24-06-06
31-06-10Ch. 1121 Federal Clarification—Elimination of Medicaid Coverage of Drugs for Treatment of Erectile Dysfunction 03/07/06 03-06-03
02-06-04
08-06-04
09-06-13
11-06-03
14-06-05
24-06-04
27-06-07
30-06-03
31-06-08
32-06-03Ch. 1150 Corrections to MA Bulletin 99-05-15 Addition of 2005 HCPCS Codes to Medical Assistance Programs Fee Schedule 03/01/06 99-06-02 Ch. 1127 Medical Assistance Program Fee Schedule Procedure Code Changes for Birth Centers 02/28/06 47-06-01 Ch. 1221 Medical Assistance Program Fee Schedule Procedure Code Changes for Independent Medical-Surgical Clinic Services 02/28/06 08-06-03 Ch. 1121 Pen and Ink Change—Preferred Drug List (PDL), Phase 4 02/20/06 27-06-06 Ch. 1130 Medical Assistance Program Fee Schedule Procedure Code Changes for Hospice Services 01/27/06 06-06-01
31-06-06Ch. 1150 Disenrollment of Dual Eligibles from Physical Health Managed Care 01/27/06 99-06-01 Ch. 1141 Medical Assistance Program Fee Schedule Procedure Code Changes for Physician Services 01/27/06 31-06-05 Ch. 1143 Medical Assistance Program Fee Schedule Procedure Code Changes for Podiatry Services 01/27/06 14-06-04 Ch. 1121 Prior Authorization of Drugs that Exceed Est. Quantity Limits—Phase 3 Enforcement and Additional Drugs with Quantity Limits 01/27/06 02-06-03
03-06-02
08-06-02
09-06-02
11-06-02
14-06-03
24-06-02
27-06-05
30-06-02
31-06-04
32-06-02Ch. 1142 Medical Assistance Program Fee Schedule Procedure Code Changes for Certified Nurse Midwife Services 01/27/06 33-06-01 Ch. 1144 Medical Assistance Program Fee Schedule Procedure Code Changes for Certified Registered Nurse Practitioner Services 01/27/06 09-06-03 Ch. 1121 Preferred Drug List—Phase 4 01/25/06 02-06-02
03-06-01
08-06-01
09-06-01
11-06-01
14-06-02
24-06-01
27-06-04
30-06-01
31-06-03
32-06-01Ch. 1221 Removal of Prior Authorization Requirement for Sleep Studies 01/12/06 01-06-02
31-06-02— Dental Behavior Management Fee Increase 01/03/06 27-06-01 Ch. 1149
1101
1150Medical Assistance Program Fee Schedule Changes for Orthodontic and Cleft Palate Services: Fee Increases, Procedure Code Changes and New Prior Authorization Requirements 01/03/06 27-06-03
17-06-01
19-06-01
20-06-01
21-06-01Ch. 1163 Place of Service Review Procedures 01/03/06 14-06-01
01-06-01
02-06-01
31-06-01
27-06-02Ch. 1150 Prudent Payment of Claims 04/03/06 99-06-04 2007 — ''Issuance of an Updated MA Program Outpatient Fee Schedule for Durable Medical Equipment, Medical Supplies, Orthotics, Prosthetics, Vision and Hearing Supplies'' included in MA Bulletin 05-05-04, et al titled ''Medical Assistance Program Fee Schedule Procedure'' 12/28/07 01-07-12
05-07-03
18-07-02
20-07-06
24-07-15
25-07-07
31-07-21— Medical Assistance Program Fee Schedule Revision 12/21/07 99-07-21 — Revision to Medical Assistance Program Fee Schedule for Federally Qualified Health Centers and Rural Health Clinics 12/21/07 08-07-16 Ch. 1150 The Addition of Isentress (raltegravir) to the Special Pharmaceutical Benefits Program 12/21/07 09-07-16
21-07-04
24-07-16
31-07-22— Nursing Facility Documentation Requirements for Movable Equipment That is Rented or Leased 12/07/07 03-07-10 — Error Reconciliation Recommendations for the National Provider Identifier (NPI) 12/01/07 99-07-20 Ch. 1123 MA Program Outpatient Fee Schedule Revisions for Speech Generating Devices 11/29/07 24-07-11
25-07-05
31-07-18Ch. 1121 Preferred Drug List—Fall Update—Part 2 11/29/07 02-07-06
11-07-07
30-07-07
03-07-09
14-07-06
31-07-20
08-07-15
24-07-14
32-07-07
09-07-14
27-07-09Ch. 1149 Fee Increase for Select Dental Procedure Codes 11/01/07 27-07-08 Ch. 1101 Childhood Nutrition and Weight Management Services for Recipients Under 21 Years of Age 11/01/07 99-07-19 Ch. 1121 Preferred Drug List—Fall 2007 Update 11/01/07 02-07-05
11-07-06
30-07-05
03-07-08
14-07-05
31-07-17
08-07-14
24-07-13
32-07-06
09-07-12
27-07-07Ch. 1141 Fee Increases for Select Office Visit and Office Consultation Procedure Codes 11/01/07 09-07-13
31-07-16
33-07-04Ch. 1121 Delay in Implementation of the Tamper—Resistant Pad Requirements 10/29/07 99-07-18 Ch. 1121 Special Pharmaceutical Benefits Program (SPBP) Income Ceiling for HIV Applicants 10/15/07 09-07-10
21-07-03
24-07-10
31-07-14Ch. 1121 Tamper Resistant Prescription Pads 09/28/07 99-07-16 Ch. 1123 2007 Power Mobility Device HCPCS Updates; Prior Authorization Requirements 09/19/07 99-07-15 — Peer Review Committee 09/14/07 99-07-14 Ch. 1145 Change in Recipient Access to Chiropractic Services 09/14/07 15-07-01 Ch. 1241 Correction of Billing Instructions for Physical and Occupational Therapy Evaluations, and Evaluations of Speech, Language, Voice, Communication and/or Auditory Processing 09/14/07 01-07-09
08-07-13
17-07-01
20-07-04
31-07-13— Updated Regarding False Claims Provisions of Deficit Reduction Act of 2005—Employee Education About False Claims Recovery 09/07/07 99-07-13 Ch. 1163 Medicare Inpatient Pricing Logic Modification 08/17/07 01-07-08 Ch. 1123 Provider Specialty 220 (Hearing Aid Dispenser Requirement and Updated Medical Assistance Program Fee Schedule for Hearing Aid Supplies 08/03/07 01-07-07
24-07-09
31-07-12
20-07-03
25-07-04— Clarification of Act 169, also known as the Older Adult Protective Services Act (OAPSA), in regard to hiring Practices for inpatient and residential facilities 08/02/07 OMHSAS-07-01 Ch. 1121 Preferred Drug List—May 2007 Technical Correction 07/31/07 02-07-04
11-07-05
30-07-04
03-07-07
14-07-04
31-07-11
08-07-12
24-07-08
32-07-05
09-07-09
27-07-06Ch. 1121 Preferred Drug List—Updates to Prior Authorization of Pharmaceutical Services Handbook Pages 07/27/07 02-07-03
11-07-04
30-07-03
03-07-06
14-07-03
31-07-10
08-07-11
24-07-07
32-07-04
09-07-08
27-07-05Ch. 1149 Discontinuance of the Prior Authorization Requirement for Dental Procedure Codes D7140 and D7210 07/11/07 27-07-04 Ch. 1249 Rescission of the Statement of Policy Clarifying the Conditions Under Which Medical Assistance Recipients May Be Considered Homebound 07/10/07 1249-07-04
99-07-12Ch. 1123 Special Pharmaceutical Benefits Program (SPBP) Income Ceiling Increase for HIV Applicants 07/01/07 09-07-05
21-07-02
24-07-04
31-07-07— Revised MA Bulletin 03-07-01: Billing Instructions—
Medicare Non-Coverage for Medicare Eligible Nursing Facility Residents06/29/07 03-07-05 Ch. 1101 The Elimination of Paper Vouchers 06/14/07 99-07-10 — Revised Citizenship and Identify Information Form 06/08/07 99-07-09 Ch. 1123 Requirements for Coverage of Enteral Nutritional Supplements and Issuance of Enteral Nutritional Supplements MA Program Outpatient Fee Schedule 06/01/07 08-07-10
09-07-07
24-07-06
25-07-03
31-07-09Ch. 1121 Preferred Drug List—July 2007 Quarterly Update 06/01/07 02-07-02
03-07-03
08-07-08
09-07-06
11-07-02
14-07-02
24-07-05
27-07-03
30-07-02
31-07-08
32-07-03Ch. 1101 Co-pay/Deductibles on Exceptional Durable Medical Equipment (DME) 06/01/07 03-07-04 — Responsibility of MA Providers to Provide Requested Medical/Psychological Information to the Disability Advocacy Program (DAP) 05/18/07 99-07-08 — Instructions for Using Your National Provider Identifier (NPI) Number to Bill the Department of Public Welfare (DPW) and Contingency Plan 05/18/07 99-07-07 Ch. 1150 Medical Assistance Program Fee Schedule Revision; Change to Conversion Factor for Anesthesia Services 05/10/07 31-07-05
32-07-0001Ch. 1243 Medical Assistance Program Fee Schedule Revision of Two Laboratory Procedure Codes 05/03/07 01-07-04
08-07-02
28-07-01Ch. 1121 Preferred Drug List—Quarterly Update 05/01/07 02-07-01
03-07-02
08-07-07
09-07-04
11-07-01
14-07-01
24-07-03
27-07-02
30-07-01
31-07-06
32-07-02Ch. 1101 Clarification Regarding the Definition of Medically Necessary—Statement of Policy 04/21/07 99-07-04
1101-07-03Ch. 1221 Pen and Ink Change—Medical Assistance Bulletin 'Medical Assistance Program Fee Schedule Procedure Code Changes For Family Planning Clinic Services' 03/30/07 08-07-06
08-05-09Ch. 1241 2007 Recommended Childhood and Adolescent Immunization Schedules 03/23/07 01-07-05
08-07-04
09-07-02
31-07-03
33-07-01Ch. 1149 Discontinuance of the Dental Services Handbook 03/23/07 27-07-1 Ch. 1241 Gardasil®, Human Papillomavirus (HPV) Vaccine 03/23/07 01-07-02
08-07-05
09-07-03
31-07-04
33-07-02Ch. 1129 Revision to Medical Assistance Program Local to National Provider Code Crosswalk for Federally Qualified Health Centers and Rural Health Clinics 03/23/07 08-07-03 Ch. 1123 Medical Assistance Program Fee Schedule Procedure Code Changes For Hearing Aid Supplies 03/01/07 01-07-02
20-07-01
31-07-01Ch. 1123 Provider Specialty 220 (Hearing Aid Dispenser) Requirement 03/01/07 01-07-03
20-07-02
24-07-01
25-07-01
31-07-02Ch. 1245 Clarification of Procedure Codes and Modifiers to be Used When Billing For Ambulance Services 02/20/07 26-07-01 — Replace MA Bulletin 03-06-12: Billing Instructions—Medicare Non-Coverage For Medicare Eligible Nursing Facility Residents 02/20/07 03-07-01 Ch. 1221 Correction to Title XIX Medical Assistance Program Family Planning Clinic Fee Schedule 02/06/07 08-07-01 Ch. 1123 Behavioral Health Fee For Service (BH-FFS) Transfer from Office of Medical Assistance Programs (OMAP) To Office of Mental Health and Substance Abuse Services (OMHSAS) 01/31/07 OMHSAS-06-07 — Revised Medical Assessment Form (PA 635) 01/12/07 01-07-01
19-07-01
09-07-01Ch. 1150 Policy Reinforcement Regarding Billing For Tobacco Cessation Counseling Services 01/04/07 99-07-02 — False Act Claims Provisions of Deficit Reduction Act of 2005 Employee Education About False Claims Recovery 01/02/07 99-07-01 2008 Ch. 1121 Preferred Drug List—Fall 2007 Update Part 2 Technical Correction 01/11/08 02-07-08
03-07-11
08-07-17
09-07-17
11-07-08
14-07-07
24-07-17
27-07-10
30-07-08
31-07-23
32-07-08Ch. 1149 Implementation of ADA Claim Form—Version 2006 and Elimination of Dental Prior Authorization Forms 01/11/08 17-08-01
19-08-01
20-08-01
21-08-01
27-08-01Ch. 1163 Preventable Serious Adverse Events 01/14/08 01-07-11 Ch. 1121 Legend Attachment to Medical Assistance Bulletin 01-07-12, et al 01/31/08 01-08-01
05-08-01
18-08-01
20-08-01
24-08-01
25-08-01
31-08-01Ch. 1101 Implementation of Select Plan for Women 02/01/08 01-08-02
08-08-02
09-08-02
24-08-03
28-08-01
31-08-03
33-08-01Ch. 1241 Clarification of Childhood Nutrition and Weight Management Services for Recipients Under 21 Years of Age 02/15/08 99-08-01 Ch. 1241 The Addition of Selzentry (maraviroc) and Intelence (etavirine) to the Special Pharmaceutical Benefits Program 02/29/08 09-08-03
24-08-04
21-08-01
31-08-04Ch. 1121 Medical Necessity Guidelines for Lyrica for Fibromyalgia 03/05/08 02-08-01
03-08-01
08-08-01
09-08-01
11-08-01
14-08-01
24-08-02
27-08-02
30-08-01
31-08-02
32-08-01Ch. 1141 Medical Assistance Program Outpatient Fee Schedule Changes for Select Chemotherapy Administration Procedure Codes 03/14/08 01-08-03
08-08-03
31-08-05Ch. 1101
1150MA Program Fee Schedule Changes—2007 HCPCS Updates; Addition of Procedure Codes and Modifiers; Prior Authorization 03/14/08 99-08-04 Ch. 1141
1126Medical Assistance Program Outpatient Fee Schedule Changes for Select Office Visit Procedure Codes 03/14/08 31-08-06
09-08-04
33-08-02Ch. 1121 Tamper Resistant Prescription Pads 03/21/08 99-08-03 Ch. 1241 2008 Recommended Childhood and Adolescent Immunization Schedules 03/21/08 01-08-04
08-08-04
09-08-05
31-08-07
33-08-07Ch. 1101 Select Plan for Women Program—Addition of Covered Services 04/23/08 01-08-05
08-08-06
09-08-07
24-08-06
28-08-03
31-08-09
33-08-04Ch. 1150 Prudent Payment of Claims—Updated 04/25/08 99-08-05 Ch. 1121 Preferred Drug List—Spring 2008 Update 06/02/08 02-08-03
03-08-03
08-08-07
09-08-08
11-08-03
14-08-03
24-08-07
27-08-04
30-08-03
31-08-10
32-08-03— Revised Error Reconciliation Recommendations for the National Provider Index (NPI) 06/05/08 99-08-07 Ch. 1149 ADA Claim Form—Version 2006 and Discontinuance of
P.O. Box 818606/16/08 17-08-02 Ch. 1123 Nursing Facility Documentation Requirements for Moveable Equipment That is Rented or Leased 07/07/08 03-08-04 Ch. 1101 Fee-For-Service Coverage for Recipients in Health Care Benefits Package 12 07/16/08 99-08-09 Ch. 1121 Prior Authorization of Early Refills of Prescriptions 07/18/08 02-08-04
11-08-04
30-08-08
03-08-08
08-08-11
09-08-12
14-08-04
24-08-08
27-08-07
31-08-15
32-08-04Ch. 1150
Ch. 1141
Ch. 1147Medical Assistance Program Fee
Increase for Select Ophthalmological
Examinations07/22/08 18-08-04
31-08-12Ch. 1150
Ch. 1249Medical Assistance (MA) Program Fee
Increases for Select Home Health Agency Services07/22/08 05-08-02 Ch. 1150
Ch. 1141
Ch. 1147Medical Assistance Program Fee
Increases for Select Office Visits and
Consultations for Vision Services07/22/08 18-08-03 Ch. 1150
Ch. 1249Medical Assistance Program Fee
Increases for Select Private Duty/Shift Nursing Services to MA Recipients Under 21 Years of Age07/22/08 05-08-03
16-08-01Ch. 1150
Ch. 1149Medical Assistance Program Fee
Increases for Select Dental Services07/22/08 27-08-06 Ch. 1150 Medical Assistance Program Fee
Increases for Select Office Visits and Consultations07/22/08 09-08-09
31-08-11
33-08-05Ch. 1150
Ch. 1243Medical Assistance Program Fee
Schedule Changes for Select Laboratory Procedure Codes07/22/08 08-08-09
09-08-10
28-08-04
31-08-13
33-08-06Ch. 1150
Ch. 1141Medical Assistance Program Outpatient
Fee Schedule Increase for a Select Colonoscopy Procedure07/22/08 01-08-07 Ch. 1150 Fee Increases for Select Healthy Beginnings Plus Services 07/25/08 05-08-04
08-08-13
31-08-17
33-08-08
47-08-11Ch. 1150
Ch. 1241Screening for Developmental Delays
and Autism Spectrum Disorders07/25/08 99-08-10 Ch. 1145 Recipient Access to Chiropractic Services 08/04/08 99-08-11 Ch. 1150 Prior Authorization of Advanced Radiologic Imaging Services 08/05/08 99-08-08 Ch. 1121 Prior Authorization of Tysabri 08/25/08 02-08-07
11-08-07
30-08-07
03-08-07
14-08-06
31-08-20
08-08-16
24-08-11
32-08-08
09-08-16Ch. 1121 Prior Authorization of Letaris, Methadone, and Myobloc 08/25/08 02-08-05
11-08-05
30-08-05
03-08-05
14-08-05
31-08-18
08-08-14
24-08-09
32-08-06
09-08-14
27-08-08Ch. 1121 Prior Authorization of Atypical Antipsychotics, Cough and Cold Medications, and Stimulants and Related Agents 08/25/08 02-08-06
11-08-06
30-08-06
03-08-06
14-08-06
31-08-19
08-08-15
24-08-10
32-08-07
09-08-15
27-08-09Ch. 1150
Ch. 1225Medical Assistance Program Family
Planning Clinic Select Fee Increases and Updates08/29/08 08-08-08 Ch. 1101
Ch. 1150
Ch. 1221Select Plan for Women Updated
Covered Services Chart09/05/08 01-08-09
08-08-17
09-08-17
24-08-12
28-08-06
31-08-21
33-08-09Ch. 1121 Prior Authorization of Erythropoiesis Stimulating Proteins 09/10/08 02-08-08
11-08-08
30-08-08
03-08-09
14-08-08
31-08-22
08-08-18
24-08-13
32-08-10
09-08-18
27-08-11Ch. 1163 Payment Policy for Hospital Readmissions 09/12/08 01-08-10 Ch. 1241 Updates for Early Periodic Screening, Diagnosis and Treatment Program 09/18/08 99-08-13 Ch. 1150
Ch. 1121Reminder of Implementation of Tamper
Resistant Prescription Pad Requirements09/24/08 99-08-14 Ch. 1121 Synagis—Updated Guidelines to Determine Medical Necessity 10/10/08 02-08-10
11-08-10
30-08-10
03-08-11
14-08-10
31-08-24
08-08-20
24-08-15
32-08-12
09-08-20
27-08-13Ch. 1121 Cytokine and CAM Antagonists—Updated Guidelines to Determine Medical Necessity 10/10/08 02-08-09
11-08-09
30-08-09
03-08-10
14-08-09
31-08-23
08-08-19
24-08-14
32-08-11
09-08-19
27-08-12Ch. 1141
1163Increase to Maximum Medical Assistance Payment to Practitioners for Services Provided During a Period of Hospitalization 10/20/08 09-08-16 Ch. 1101
1150Implementation of Claim Check 10/20/08 99-08-17 — Specialty Pharmacy Drug Program 10/20/08 99-09-01 Ch. 1121 Non-Payment of Anti-dementia Drugs for Children Less Than 18 Years of Age 10/20/08 99-08-15 Ch. 1121 Preferred Drug List 2008 Update 10/31/08 02-08-11
03-08-12
08-08-21
09-08-21
11-08-11
14-08-11
24-08-16
27-08-14
30-08-11
31-08-25
32-08-13Ch. 1101
Ch. 1150Implementation of Claim Check 10/02/08 99-08-17 Ch. 1121 Grandfathering of Prescriptions for Non-Preferred Atypical Antipsychotics for Children Under Six (6) Years of Age 11/07/08 02-08-12
11-08-12
30-08-12
03-08-13
14-08-12
31-08-26
08-08-22
24-08-17
32-08-14
09-08-22
27-08-15Ch. 1150
Ch. 1147Addition of Procedure Code 67820 to
Optometrist Medical Assistance Program Outpatient Fee Schedule11/14/08 18-08-07 Ch. 1150 Preventable Serious Adverse Events 11/26/08 01-08-11 — Special Pharmaceutical Benefits Program (SPBP)—Updated Eligibility Criteria for SP1 Card Holders 12/05/08 08-08-23
09-08-23
24-08-18
01-08-04
31-08-27Ch. 1150
Ch. 1147Addition of Procedure Codes to the Medical Assistance Program Fee Schedule for Office Visits for Optometrists 12/29/08 18-09-01 2009 Ch. 1150
Ch. 1123
Ch. 1147Removal of Prior Authorization Requirement for Eyeglass Lenses 02/09/09 18-09-02
24-09-01
25-09-01
31-09-01Ch. 1101
Ch. 1150
Ch. 1241Pentacel® (DTaP-IPV/Hib), Kinrix® (DTaP-IPV) and Rotarix® (Rotavirus)
Vaccines02/09/09 01-09-01
08-09-01
09-09-01
31-09-02
33-09-01— Special Pharmaceutical Benefits Program (SPBP)—
2009 Federal Poverty Guidelines for SP1 Card Holders02/13/09 01-09-03
24-09-03
08-09-03
28-09-02
09-09-03
31-09-04
21-09-02Ch. 1101
Ch. 1150
Ch. 12412009 Recommended Childhood and
Adolescent Immunization Schedules02/20/09 01-09-04
08-09-04
09-09-04
31-09-05
33-09-02— Clarifying Medical Assistance (MA) Policy related to Medicare Cost Sharing under Part D for Dual Eligible Recipients in the MA Program 03/10/09 99-09-02 — Clarification of Procedures for Responding to Requests for Copies of Medical Assistance (MA) Recipients' Bills 03/20/09 99-09-03 Ch. 1121 Prior Authorization of Hypoglycemics, Incretin Mimetics—Enhancers 03/20/09 02-09-01
11-09-01
30-09-01
03-09-01
14-09-01
31-09-06
08-09-05
24-09-04
32-09-01
09-09-05
27-09-01Ch. 1150 Medical Assistance Program Fee Schedule Procedure Code End-dating of Keratomileusis 03/27/09 99-09-04 Ch. 1149 Implementation of the Pediatric Dental Periodicity Schedule 04/24/09 27-09-02 Ch. 1121 Medical Necessity Guidelines for Cymbalta for Treatment of Fibromyalgia 05/22/09 01-09-05
02-09-02
03-09-02
08-09-06
09-09-06
11-09-02
14-09-02
24-09-05
27-09-03
30-09-02
31-09-07
32-09-02Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update 06/05/09 01-09-06
09-09-07
27-09-04
02-09-03
11-09-03
30-09-03
03-09-03
14-09-08
31-09-08
08-09-07
24-09-06
32-09-03Ch. 1150 Revisions to Medical Assistance Program Fee Schedule Rates for Select Services 06/15/09 99-09-05 Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Cytokine and CAM Antagonists Updated Handbook Pages 06/19/09 01-09-09
02-09-06
03-09-06
08-09-10
09-09-10
11-09-06
14-09-06
24-09-09
27-09-07
30-09-06
31-09-11
332-09-06Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Hypoglycemics, Insulins Updated Handbook Pages 06/19/09 01-09-07
02-09-04
03-09-04
08-09-08
09-09-08
11-09-04
14-09-04
24-09-07
27-09-05
30-09-04
31-09-09
32-09-04Ch. 1121 Automated Prior Authorization of Pharmacy Services—
Stimulants and Related Agents Updated Handbook Pages06/29/09 01-09-11
08-09-12
14-09-08
30-09-08
02-09-08
09-09-12
24-09-11
31-09-13
03-09-08
11-09-08
27-09-08
32-09-08Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Antibiotics, GI Updated Handbook Pages 06/29/09 01-09-26
02-09-23
03-09-23
08-09-27
09-09-27
11-09-23
14-09-23
24-09-26
27-09-23
30-09-23
31-09-28
32-09-23Ch. 1121 Automated Prior Authorization of Pharmacy Services—Bronchodilators, Beta Agonist Updated Handbook Pages 06/29/09 01-09-25
02-09-22
03-09-22
08-09-26
09-09-26
11-09-22
14-09-22
24-09-25
27-09-22
30-09-22
31-09-27
32-09-22Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Inhaled Glucocorticoids Updated Handbook Pages 06/29/09 01-09-17
02-09-14
03-09-14
08-09-18
09-09-18
11-09-14
14-09-14
24-09-17
27-09-14
30-09-14
31-09-19
32-09-14Ch. 1121 Automated Prior Authorization of Pharmacy Services—Sedative Hypnotics Updated Handbook Pages 06/29/09 01-09-12
08-09-13
14-09-09
30-09-09
02-09-09
09-09-13
24-09-12
31-09-14
03-09-09
11-09-09
27-09-09
32-09-09Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Oral Antifungals Updated Handbook Pages 06/29/09 01-09-16
02-09-13
03-09-13
08-09-17
09-09-17
11-09-13
14-09-13
24-09-16
27-09-13
30-09-13
31-09-18
32-09-13Ch. 1121 Automated Prior Authorization of Pharmacy Services—
Minimally Sedating Antihistamines Updated Handbook Pages06/29/09 01-09-23
02-09-20
03-09-20
08-09-24
09-09-24
11-09-20
14-09-20
24-09-23
27-09-20
30-09-20
31-09-25
32-09-20Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—
Pulmonary Arterial Hypertension (PAH) Agents Handbook Pages06/29/09 01-09-13
08-09-14
14-09-10
30-09-10
02-09-10
09-09-14
24-09-13
31-09-15
03-09-10
11-09-10
27-09-10
32-09-10Ch. 1121 Automated Prior Authorization of Pharmacy Services—
Ophthalmic Immunomodulators Updated Handbook Pages06/29/09 01-09-14
08-09-15
14-09-11
30-09-11
02-09-11
09-09-15
24-09-14
31-09-16
03-09-11
11-09-11
27-09-11
32-09-11Ch. 1121 Automated Prior Authorization of Pharmacy Services—
Antidepressants, SSRIs Updated Handbook Pages06/29/09 01-09-22
02-09-19
03-09-19
08-09-23
09-09-23
11-09-19
14-09-19
24-09-22
27-09-19
30-09-19
31-09-24
32-09-19Ch. 1121 Automated Prior Authorization of Pharmacy Services—
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)06/29/09 01-09-24
02-09-21 03-09-21
08-09-25
09-09-25
11-09-21
14-09-21
24-09-24
27-09-21
30-09-21
31-09-26
32-09-21Ch. 1121 Pharmacy Update—Oral Fluoroquinolones Updated Handbook Pages 06/29/09 01-09-20
02-09-17
03-09-17
08-09-21
09-09-21
11-09-17
14-09-17
24-09-20
27-09-17
30-09-17
31-09-22
32-09-17Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—
Intranasal Rhinitis Agents Updated Handbook Pages06/29/09 01-09-18
02-09-15
03-09-15
08-09-19
09-09-19
11-09-15
14-09-15
24-09-18
27-09-15
30-09-15
31-09-20
32-09-15Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—
Growth Hormones Updated Handbook Pages06/29/09 01-09-19
02-09-16
03-09-16
08-09-20
09-09-20
11-09-16
14-09-16
24-09-19
27-09-16
30-09-16
31-09-21
32-09-16Ch. 1121 Automated Prior Authorization of Pharmacy Services—
Bronchodilators, Anticholinergic Updated Handbook Pages06/29/09 01-09-21
02-09-18
03-09-18
08-09-22
09-09-22
11-09-18
14-09-18
24-09-21
27-09-18
30-09-18
31-09-23
32-09-18Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Acne Agents, Oral Updated Handbook Pages 06/29/09 01-09-10
08-09-11
14-09-07
30-09-07
02-09-07
09-09-11
24-09-10
31-09-12
03-09-07
11-09-07
27-09-08
32-09-07Ch. 1121 Automated Prior Authorization of Pharmacy Services—
Lipotropics, Statins Updated Handbook Pages06/29/09 01-09-15
02-09-12
03-09-12
08-09-16
09-09-16
11-09-12
14-09-12
24-09-15
27-09-12
30-09-12
31-09-17
32-09-12Ch. 1150 2008 HCPCS Updates and Other Procedure Code and Procedure Code/Modifier Combination Changes 07/06/09 99-09-06 Ch. 1121 Prior Authorization of Benzodiazepines—Pharmacy Services 07/27/09 01-09-31
02-09-28
03-09-28
08-09-32
09-09-32
11-09-28
14-09-28
24-09-31
27-09-29
30-09-28
31-09-33
32-09-28Ch. 1121 Prior Authorization of Buprenorphine Agents (Suboxone and Subutex)—Pharmacy Services 07/27/09 01-09-30
02-09-27
03-09-27
08-09-31
09-09-31
11-09-27
14-09-27
24-09-30
27-09-28
30-09-27
31-09-32
32-09-27Ch. 1121 Prior Authorization of Topical Acne Agents—Pharmacy Services 07/27/09 01-09-28
02-09-25
03-09-25
08-09-29
09-09-29
11-09-25
14-09-25
24-09-28
27-09-26
30-09-29
31-09-30
32-09-25Ch. 1121 State Maximum Allowable Cost (MAC) List (Including the Federal Upper Limit)—Pharmacy Services 07/27/09 01-09-32
02-09-29
03-09-29
08-09-33
09-09-33
11-09-29
14-09-29
24-09-32
27-09-30
30-09-29
31-09-34
32-09-29Ch. 1121 Prior Authorization of Cough and Cold Medications for Children Under Six (6) years of Age—Pharmacy Services 07/27/09 01-09-27
02-09-24
03-09-24
08-09-28
09-09-28
11-09-24
14-09-24
24-09-27
27-09-25
30-09-04
31-09-29
32-09-24— Special Pharmaceutical Benefits Program (SPBP)—Addition of CD4 Tests to the List of Outpatient Laboratory Services for SP1 Card Holders 08/03/09 01-09-33
08-09-34
09-09-35
21-09-03
24-09-33
28-09-03
31-09-36Ch. 1105, 1150 Revised Medical Assessment Form (PA 635) 08/10/09 31-09-38
19-09-01
09-09-34Ch. 1121 Prior Authorization of Skeletal Muscle Relaxants—
Pharmacy Services08/10/09 01-09-35
09-09-37
27-09-32
02-09-31
11-09-31
30-09-31
03-09-31
14-09-31
31-09-38
08-09-36
24-09-35
32-09-31Ch. 1121 Prior Authorization of Narcotic Analgesics—Pharmacy Services 08/10/09 01-09-34
09-09-36
27-09-31
02-09-30
11-09-30
30-09-30
03-09-30
14-09-30
31-09-37
08-09-35
24-09-34
32-09-30Ch. 1101
Ch. 1150Changes to Procedure Codes for the
Administration Fees for Kinrix® (DTaP-IPV) and Rotarix® (Rotavirus) Vaccines08/13/09 01-09-38
08-09-39
09-09-40
31-09-41
33-09-03Ch. 1101
1150, 1141
1221Select Plan for Women Program Formulary 09/01/09 01-09-39
08-09-40
09-09-41
24-09-38
28-09-04
31-09-42
33-09-04Ch. 1121 Prior Authorization of Atypical Antipsychotics—
Pharmacy Services09/01/09 01-09-36
09-09-38
27-09-33
02-09-32
11-09-32
30-09-32
03-09-32
14-09-32
31-09-39
08-09-37
24-09-36
32-09-32Ch. 1101, 1150
1141
1221Select Plan for Women Program— Addition of Covered Services 09/08/09 01-09-40
08-09-41
09-09-42
24-09-39
28-09-05
31-09-43
33-09-05Ch. 1150
1241
Structured Screening for Developmental
Delays and Autism Spectrum Disorders
09/08/09
99-09-07
Ch. 1121 Prior Authorization of Neulasta—Pharmacy Services 09/17/09 01-09-29 02-09-26
03-09-26
08-09-30
09-09-30
11-09-26
14-09-26
24-09-29
27-09-27
30-09-26
31-09-31
32-09-26Ch. 1121 Prior Authorization of Conventional (Typical) Antipsychotics—Pharmacy Services 09/21/09 01-09-37
09-09-39
27-09-34
02-09-33
11-09-33
30-09-33
03-09-33
14-09-33
31-09-40
08-09-38
24-09-37
32-09-33Ch. 1121 Available Resources: 2009 Novel Influenza Virus A (H1N1) 09/24/09 01-09-41
08-09-42
09-09-43
31-09-44
33-09-06Ch. 1141 Revisions to the Medical Assistance Program Fee Schedule Rates for Select Services 10/05/09 99-09-09 Ch. 1150 Billing for the Administration of the Influenza A (H1N1) 2009 Monovalent Vaccine 10/09/09 99-09-10 Ch. 1101 1141
1142
1143
1144
1145, 1147
1149Revision of the PROMISe® Individual
Practitioner Enrollment Application and Implementation of Credentialing for Certain
Providers Types10/16/09 99-09-08 Ch. 1121 Prior Authorization of Proton Pump Inhibitors (PPIs)—
Pharmacy Services10/20/09 01-09-42
08-09-43
14-09-34
30-09-34
02-09-34
09-09-44
24-09-40
31-09-45
03-09-34
11-09-34
27-09-35
32-09-34Ch. 1121 Fall 2009 Preferred Drug List (PDL) and Quantity Limits Update—Pharmacy Services 11/02/09 01-09-43
09-09-45
27-09-36
02-09-35
11-09-35
30-09-35
03-09-35
14-09-35
31-09-46
08-09-44
24-09-41
32-09-35Ch. 1141 1145 Recipient Access to Chiropractic
Services11/30/09 99-09-11 Ch. 1121 Steroids, Topical Low Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-51
09-09-53
27-09-44
02-09-43
11-09-43
30-09-43
03-09-43
14-09-43
31-09-54
08-09-52
24-09-49
32-09-43Ch. 1121 Ophthalmic Antibiotics Updated Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-58
09-09-59
27-09-50
02-09-49
11-09-49
30-09-49
03-09-49
14-09-49
31-09-60
08-09-58
24-09-55
32-09-49Ch. 1121 Steroids, Topical High Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-54
09-09-55
27-09-46
02-09-45
11-09-45
30-09-45
03-09-45
14-09-45
31-09-56
08-09-54
24-09-51
32-09-45Ch. 1121 Platelet Aggregation Inhibitors Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-47
09-09-49
27-09-40
02-09-39
11-09-39
30-09-39
03-09-39
14-09-39
31-09-50
08-09-48
24-09-45
32-09-39Ch. 1121 Pharmacy Services Fall 2009 Preferred Drug List (PDL) Pharmacy Update—Bronchodilators, Beta Agonists Updated Handbook Pages 11/02/09 01-09-48
09-09-50
27-09-41
02-09-40
11-09-40
30-09-40
03-09-40
14-09-40
31-09-51
08-09-49
24-09-46
32-09-40Ch. 1121 Antivirals, Topical Updated Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-57
09-09-58
27-09-49
02-09-48
11-09-48
30-09-48
03-09-48
14-09-48
31-09-59
08-09-57
24-09-54
32-09-48Ch. 1121 Ophthalmic Anti-Inflammatories New Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-49
09-09-51
27-09-42
02-09-41
11-09-41
30-09-41
03-09-41
14-09-41
31-09-52
08-09-50
24-09-47
32-09-41Ch. 1121 Pancreatic Enzymes Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-50
09-09-52
27-09-43
02-09-42
11-09-42
30-09-42
03-09-42
14-09-42
31-09-53
08-09-51
24-09-48
32-09-42Ch. 1121 Steroids, Topical Very High Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-55
09-09-56
27-09-47
02-09-46
11-09-46
30-09-46
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32-09-46Ch. 1121 Fall 2009 Preferred Drug List (PDL) and Quantity Limits Update—Pharmacy Services 11/02/09 01-09-44
09-09-46
27-09-37
02-09-36
11-09-36
30-09-36
03-09-36
14-09-36
31-09-47
08-09-45
24-09-42
32-09-36Ch. 1121 Steroids, Topical Medium Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-52
09-09-54
27-09-45
02-09-44
11-09-44
30-09-44
03-09-44
14-09-44
31-09-55
08-09-53
24-09-50
32-09-44Ch. 1121 Antidepressants, Other Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-45
09-09-47
27-09-38
02-09-47
11-09-37
30-09-37
03-09-47
14-09-37
31-09-48
08-09-46
24-09-43
32-09-37Ch. 1121 Antifungals, Oral Updated Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-46
09-09-48
27-09-39
02-09-38
11-09-38
30-09-38
03-09-38
14-09-38
31-09-49
08-09-47
24-09-44
32-09-38Ch. 1121 Bone Resorption Suppression and Related Agents Updated Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-56
09-09-57
27-09-48
02-09-47
11-09-47
30-09-47
03-09-47
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24-09-53
32-09-47Ch. 1143 Correction to Medical Assistance Bulletin 14-06-04 for Podiatrists 11/30/09 14-09-50 Ch. 1121 Prior Authorization and Quantity Limits of Botulinum Toxins—Pharmacy Services 12/11/09 01-09-61
09-09-62
27-09-53
02-09-52
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24-09-58
32-09-52Ch. 1121 Preferred Drug List (PDL) New Drugs to Market Handbook Pages—Pharmacy Services 12/11/09 01-09-60
09-09-61
27-09-52
02-09-51
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30-09-51
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32-09-51— Prone Restraints in Children's Facilities 12/19/09 3800-09-02 — Strategies and Practices to Eliminate the Use of Unnecessary Restraints 12/19/09 3800-09-01 Ch. 1101 1150
1241Hiberix®, Haemophilus Influenzae
Type b (Hib) Vaccine12/31/09 01-09-62
08-09-61
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31-09-64
33-09-072010 — Special Pharmaceutical Benefits Program (SPBP)-Implementation of the Revised HIV/AIDS Formulary for SP1 Cardholders 01/25/10 08-10-02
09-10-02
24-10-02
31-10-02Ch. 1121 List of Drugs with Established Quantity Limits/Daily Dose Limits—Pharmacy Services 01/29/10 01-10-01
09-10-01
27-10-01
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32-10-01Ch. 1121 Prior Authorization of Erythropoiesis Stimulating Proteins—Pharmacy Services 01/29/10 01-10-03
09-10-04
27-10-02
02-10-01
11-10-01
30-10-01
03-10-01
14-10-01
31-10-01
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09-10-06
27-10-04
02-10-04
11-10-04
30-10-04
03-10-04
14-10-04
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08-10-03
09-10-03
18-10-01
28-10-01
29-10-01
31-10-03Ch. 1147 Medical Assistance Program Outpatient Fee Schedule Procedure Code Changes for Vision Services 02/15/10 18-10-02
31-10-05Ch. 1150 Medical Assistance Program Fee Schedule Revisions 02/19/10 99-10-01 Ch. 1101
1150
12412010 Recommended Childhood and
Adolescent Immunization Schedules03/15/10 01-10-06
08-10-07
09-10-07
31-10-09
33-10-01Ch. 1141
1144
Application of Topical Fluoride
Varnish by Physicians and CRNPs
03/15/10
09-10-08
31-10-08
Ch. 1121 Prior Authorization of Neulasta—Pharmacy Services 04/01/10 01-10-07
09-10-09
27-10-05
02-10-05
11-10-05
30-10-05
03-10-05
14-10-05
31-10-10
08-10-08
24-10-06
32-10-05Ch. 1121 Oral Buprenorphine Agents Updated Handbook Pages—
Pharmacy Services04/03/10 01-10-04
09-10-05
27-10-03
02-10-03
11-10-03
30-10-03
03-10-03
14-10-03
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24-10-04
32-10-03— Implementation of New Physical Health Managed Care Organizations in the HealthChoices Southeast and Lehigh/Capital Zones 04/23/10 99-10-02 Ch. 1121 Analgesics, Narcotic Long Acting Handbook Pages Pharmacy Services Spring 2010 Preferred Drug List (PDL) Update 05/01/10 01-10-15
09-10-17
27-10-12
02-10-12
11-10-12
30-10-12
03-10-13
14-10-12
31-10-18
08-10-16
24-10-13
32-10-12Ch. 1121 Fibromyalgia Agents Handbook Pages Pharmacy Services Spring 2010 Preferred Drug List (PDL) Update 05/03/10 01-10-10
09-10-12
27-10-08
02-10-08
11-10-08
30-10-08
03-10-08
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32-10-08Ch. 1121 Spring 2010 Preferred Drug List (PDL) Quantity Limits Update—Pharmacy Services 05/03/10 01-10-08
09-10-10
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30-10-06
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08-10-09
24-10-07
32-10-06Ch. 1121 Oral Immunosuppressive Handbook Pages Pharmacy Services Spring 2010 Preferred Drug List (PDL) Update 05/03/10 01-10-12
09-10-14
27-10-10
02-10-10
11-10-10
30-10-10
03-10-10
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31-10-15
08-10-13
24-10-11
32-10-10— Limitation on Allowable Other Medical Expenses Related to Nursing Facility Services 05/03/10 03-10-02 Ch. 1121 Multiple Sclerosis Agents Handbook Pages Pharmacy Services Spring 2010 Preferred Drug List (PDL) Update 05/03/10 01-10-13
09-10-15
27-10-11
02-10-11
11-10-11
30-10-11
03-10-11
14-10-11
31-10-16
08-10-14
24-10-12
32-10-11Ch. 1121 Hepatitis C Agents Handbook Pages Pharmacy Services Spring 2010 Preferred Drug List (PDL) Update 05/03/10 01-10-11
09-10-13
27-10-09
02-10-09
11-10-09
30-10-09
03-10-09
14-10-09
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08-10-12
24-10-10
32-10-09Ch. 1121 Antidepressants, Other Handbook Pages Pharmacy Services Spring 2010 Preferred Drug List (PDL) Update 05/03/10 01-10-09
09-10-11
27-10-07
02-10-07
11-10-07
30-10-07
03-10-07
14-10-07
31-10-12
08-10-10
24-10-08
32-10-07Ch. 1121 Oral Anticonvulsants Handbook Pages Pharmacy Services Spring 2010 Preferred Drug List (PDL) Update 05/21/10 01-10-18
09-10-20
27-10-15
02-10-15
11-10-15
30-10-15
03-10-16
14-10-15
31-10-21
08-10-19
24-10-16
32-10-15Ch. 1121 Angiotensin Modulator Combinations Handbook Pages Pharmacy Services Spring 2010 Preferred Drug List (PDL) Update 05/21/10 01-10-17
09-10-19
27-10-14
02-10-14
11-10-14
30-10-14
03-10-15
14-10-14
31-10-20
08-10-18
24-10-15
32-10-14Ch. 1121 Pulmonary Arterial hypertension Agents, Oral and Inhaled Handbook Pages Pharmacy Services Spring 2010 Preferred Drug List (PDL) Update 05/21/10 01-10-16
09-10-18
27-10-13
02-10-13
11-10-13
30-10-13
03-10-14
14-10-13
31-10-19
08-10-17
24-10-14
32-10-13Ch. 1121 Analgesics, Narcotic Short Acting Handbook Pages Pharmacy Services Spring 2010 Preferred Drug List (PDL) Update 05/21/10 01-10-19
09-10-21
27-10-16
02-10-16
11-10-16
30-10-16
03-10-17
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32-10-16Ch. 1101
1150Announcing the Federally Mandated Change to Electronic Healthcare Transactions for Healthcare and Pharmacy Transactions 06/08/10 99-10-07 Ch. 1101
1150
1241Revisions to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule 06/14/10 99-10-06 Ch. 1150 2009 HCPCS Updates and Other Procedure Code and Procedure Code/Modifier Combination Changes 06/14/10 99-10-05 Ch. 1150 Health Care Benefit Package 12 Updated Employability Assessment Procedure Code List 07/09/10 01-10-20
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31-10-23Ch. 41 Change of Protocol for Certain Provider Appeals 07/09/10 99-10-08 Ch. 1101
1102
1121
1123
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1243Policy Clarification Regarding Written Prescriptions—
Statement of Policy07/17/10 99-10-03
1101-10-01
1102-10-01
1121-10-01
1123-10-01
1149-10-01
1151-10-01
1163-10-01
1181-10-01
1187-10-01
1230-10-01
1243-10-01Ch. 1121 Prior Authorization of Spiriva (Bronchodilators, Anticholinergic)—Pharmacy Services 07/29/10 01-10-21
09-10-23
27-10-17
02-10-17
11-10-17
30-10-17
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32-10-17Ch. 1101 Select Plan for Women—Update to Covered Services 07/30/10 01-10-22
08-10-24
09-10-21
24-10-19
28-10-03
31-10-26
33-10-03Ch. 1225 Changes to the Provision of Hemoglobin Laboratory Services by Family Planning Clinics 07/30/10 08-10-23 Ch. 1121 Electronic Prescribing for Providers That Have ePrescribing Software 08/04/10 03-10-19
09-10-25
14-10-18
18-10-04
24-10-20
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09-10-28
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32-10-20Ch. 1121 Prior Authorization of Analgesics, Narcotic Short Acting—
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09-10-27
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32-10-19Ch. 1121 Updated List of Drugs with Established Quantity Limits/Daily Dose Limits—Pharmacy Services 08/27/10 01-10-23
09-10-26
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32-10-18Ch. 1101
1150
1241Updates to the Medical Assistance Program Fee Schedule for the Administration of the Vaccines Prevnar 13®, Cervarix®, Twinrix®, Recombivax HB®, and Menveo® 08/30/10 01-10-27
08-10-28
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31-10-30
33-10-05Ch. 1150 Revisions to the Medical Assistance Program Fee Schedule Rates for Select Services 08/30/10 99/10/09 Ch. 1121
Retrospective Drug Use Review—Pharmacy Services
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99-10-10
Ch. 1121 Specialty Pharmacy Drug Program—Updated List of Covered Drugs—Pharmacy Services 09/27/10 99-10-11 Ch. 1145 Recipient Access to Chiropractic Services 10/08/10 99-10-12 Ch. 1121 Antipsychotics Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/05/10 01-10-33
09-10-35
27-10-25
02-10-24
11-10-24
30-10-24
03-10-26
14-10-25
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08-10-34
24-10-27
32-10-24Ch. 1121 Analgesics/Anesthetics, Topical Agents Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/05/10 01-10-29
09-10-31
27-10-21
02-10-20
11-10-20
30-10-20
03-10-22
14-10-21
31-10-32
08-10-30
24-10-23
32-10-20Ch. 1121 Intranasal Rhinitis Agents Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/05/10 01-10-41
09-10-43
27-10-33
02-10-32
11-10-32
30-10-32
03-10-34
14-10-33
31-10-44
08-10-42
24-10-35
32-10-32Ch. 1121 Oral Fluoroquinolones Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/05/10 01-10-39
09-10-41
27-10-31
02-10-30
11-10-30
30-10-30
03-10-32
14-10-31
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32-10-30Ch. 1121 Fall 2010 Preferred Drug List (PDL) and Quantity Limits Update—Pharmacy Services 11/05/10 01-10-28
09-10-30
27-10-20
02-10-19
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30-10-19
03-10-21
14-10-20
31-10-31
08-10-29
24-10-22
32-10-19Ch. 1121 Inhaled Glucocorticoids Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/05/10 01-10-40
09-10-42
27-10-32
02-10-31
11-10-31
30-10-31
03-10-33
14-10-32
31-10-43
08-10-41
24-10-34
32-10-31Ch. 1121 Antihyperuricemics Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/05/10 01-10-31
09-10-33
27-10-23
02-10-22
11-10-22
30-10-22
03-10-24
14-10-23
31-10-34
08-10-32
24-10-25
32-10-22Ch. 1121 Bronchodilators, Beta Agonists Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/05/10 01-10-37
09-10-39
27-10-29
02-10-28
11-10-28
30-10-28
03-10-30
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08-10-38
24-10-31
32-10-28Ch. 1121 Antivirals, Oral Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/05/10 01-10-34
09-10-36
27-10-26
02-10-25
11-10-25
30-10-25
03-10-27
14-10-26
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08-10-35
24-10-28
32-10-25Ch. 1121 Macrolides/Ketolides Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/05/10 01-10/42
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27-10-34
02-10-33
11-10-33
30-10-33
03-10-35
14-10-34
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08-10-43
24-10-36
32-10-33Ch. 1121 Antibiotics, Inhaled Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/05/10 01-10-30
09-10-32
27-10-22
02-10-21
11-10-21
30-10-21
03-10-23
14-10-22
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08-10-31
24-10-24
32-10-21Ch. 1121 Bone Resorption Suppression and Related Agents Handbook Pages—Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/05/10 01-10-30
09-10-32
27-10-22
02-10-21
11-10-21
30-10-21
03-10-23
14-10-22
31-10-33
08-10-31
24-10-24
32-10-21Ch. 1121 Bile Salts Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/05/10 01-10-35
09-10-37
27-10-27
02-10-26
11-10-26
30-10-26
03-10-28
14-10-27
31-10-38
08-10-36
24-10-29
32-10-26Ch. 1121 Antiparasitics, Topical Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/05/10 01-10-32
09-10-34
27-10-24
02-10-23
11-10-23
30-10-23
03-10-25
14-10-24
31-10-35
08-10-33
24-10-26
32-10-23Ch. 1121 Cytokine and CAM Antagonists Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/05/10 01-10-38
09-10-40
27-10-30
02-10-29
11-10-29
30-10-29
03-10-31
14-10-30
31-10-41
08-10-39
24-10-32
32-10-29Ch. 1121 Alzheimer's Agents Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/12/10 01-10-49
09-10-51
27-10-41
02-10-40
11-10-40
30-10-40
03-10-42
14-10-41
31-10-52
08-10-50
24-10-43
32-10-40Ch. 1121 Ophthalmic Antibiotics Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/12/10 01-10-44
09-10-46
02-10-35
11-10-35
30-10-35
03-10-37
14-10-36
31-10-47
08-10-45
24-10-38
32-10-35Ch. 1121 Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Handbook Pages—Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/12/10 01-10-43
09-10-45
27-10-35
02-10-34
11-10-34
30-10-34
03-10-36
14-10-35
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32-10-34Ch. 1101
1121Requirement for Prescribing Provider
National Provider Identifier (NPI) Number on Outpatient Pharmacy Claims—Pharmacy Services11/12/10 99-10-13 Ch. 1121 Cephalosporins Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/12/10 01-10-48
09-10-50
27-10-40
02-10-39
11-10-39
30-10-39
03-10-41
14-10-40
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08-10-49
24-10-42
32-10-39Ch. 1121 Stimulants and Related Agents Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/12/10 01-10-47
09-10-49
27-10-39
02-10-38
11-10-38
30-10-38
03-10-40
14-10-39
31-10-50
08-10-48
24-10-41
32-10-38Ch.1121 Platelet Aggregation Inhibitors Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/12/10 01-10-46
09-10-48
27-10-38
02-10-37
11-10-37
30-10-37
03-10-39
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08-10-47
24-10-40
32-10-37Ch. 1121 Ophthalmic Anti-Inflammatories Handbook Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 11/12/10 01-10-45
09-10-47
27-10-37
02-10-36
11-10-36
30-10-36
03-10-38
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08-10-46
24-10-39
32-10-36Ch. 1129 Dental Encounter payment for Dental Services Rendered by Rural Health Clinics and Federally Qualified Health Centers 11/15/10 08-10-50 Ch. 1245
1187Payment for Non-Emergency Transportation Services 11/24/10 03-10-43
26-10-01Ch. 1121 Incretin Mimetic/Enhancer Hypoglycemics Pages Pharmacy Services Fall 2010 Preferred Drug List (PDL) Update 12/01/10 01-10-50
09-10-51
27-10-42
02-10-41
11-10-42
30-10-41
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32-10-41Ch. 1101 Missed Appointments 12/01/10 99-10-14 Ch. 1101
1150
1241Medical Assistance Program Coverage of the 2010-2011 Influenza Vaccines 12/01/10 99-10-16 Ch. 1121 Oral Buprenorphine Agents Updated Handbook Pages—
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09-10-52
27-10-42
02-10-42
11-10-42
30-10-42
03-10-45
14-10-43
31-10-54
08-10-52
24-10-45
32-10-42Ch. 1121 Hypoglycemics, TZDs Updated Handbook Pages—Pharmacy Services 12/20/10 01-10-52
09-10-53
27-10-43
02-10-43
11-10-43
30-10-43
03-10-46
14-10-44
31-10-55
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24-10-46
32-10-43Ch. 1121 Prior Authorization of Topamax/Topiramate Oral Anticonvulsants Updated Handbook Pages—Pharmacy Services 12/24/10 01-10-53
09-10-54
27-10-44
02-10-44
11-10-44
30-10-44
03-10-47
14-10-45
31-10-56
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32-10-44Ch. 1121 Prior Authorization of Methadone in Analgesics, Narcotic Long Acting Updated Handbook Pages—Pharmacy Services 12/24/10 01-10-54
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02-10-45
11-10-45
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14-10-46
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32-10-45— Complex Case Planning 12/28/10 00-10-02 2011 Ch. 1150 2010 HCPCS Updates and Other Procedure Code and Procedure Code/Modifier Combination Changes 01/03/11 99-11-01 Ch. 1123 Change in Billing of Repairs and Replacements for Durable Medical Equipment 01/14/11 24-11-01 Ch. 1101
1150Medical Assistance Electronic Health Records (EHR) Incentive Program for Eligible Professionals 01/25/11 08-11-02
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1150Medical Assistance Electronic Health Records (EHR) Incentive Program for Eligible Hospitals 01/28/11 01-11-01 Ch. 1225 Rescind MA Program Fee Increase for Oral Contraceptives Dispensed by Family Planning Clinics 02/09/11 08-11-03 Ch. 1241 2011 Recommended Childhood and Adolescent Immunization Schedules 03/18/11 01-11-04
08-11-06
09-11-05
31-11-05
33-11-04Ch. 1101
1150MA Program Outpatient Fee Schedule Decrease for Select Incontinence Products 04/05/11 24-11-02
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14-11-01
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24-11-04
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1150Medical Assistance Electronic Health Record (EHR) Incentive Program Application Process for Eligible Professionals (EP) 05/13/11 08-11-07
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31-11-06
33-11-05Ch. 1101
1150Medical Assistance Electronic Health (EHR) Incentive Program Application Process for Eligible Hospitals 05/13/11 01-11-05 Ch. 1121 Prior Authorization of Androgenic Agents—Pharmacy Services 05/26/11 01-11-06
09-11-07
27-11-04
02-11-01
11-11-01
30-11-01
03-11-02
14-11-02
31-11-07
08-11-08
24-11-05
32-11-01Ch. 1121 Prior Authorization of Angiotensin Modulators—Pharmacy Services 05/26/11 01-11-10
09-11-11
27-11-08
02-11-05
11-11-05
30-11-05
03-11-06
14-11-06
31-11-11
08-11-12
24-11-09
32-11-05Ch. 1121 Prior Authorization of Antidepressants, SSRIs—Pharmacy Services 05/26/11 01-11-08
09-11-09
27-11-06
02-11-03
11-11-03
30-11-03
03-11-04
14-11-04
31-11-09
08-11-10
24-11-07
32-11-03Ch. 1121 Prior Authorization of Atypical Antipsychotics—Pharmacy Services 05/26/11 01-11-09
09-11-10
27-11-07
02-11-04
11-11-04
30-11-04
03-11-05
14-11-05
31-11-10
08-11-11
24-11-08
32-11-04Ch. 1121 Prior Authorization of Proton Pump Inhibitors (PPIs)—
Pharmacy Services05/26/11 01-11-07
09-11-08
27-11-05
02-11-02
11-11-02
30-11-02
03-11-03
14-11-03
31-11-09
08-11-09
24-11-06
32-11-02Ch. 1150 Revisions to the Medical Assistance Program Fee Schedule Rates for Select Services 05/30/11 99-11-02 Ch. 1121 Prior Authorization of Multiple Sclerosis Agents—Pharmacy Services 06/08/11 01-11-17 Ch. 1121 Prior Authorization of Antihyperuricemics—Pharmacy Services 06/08/11 01-11-16
09-11-17
27-11-14
02-11-11
11-11-11
30-11-11
03-11-12
14-11-12
31-11-17
08-11-18
24-11-15
32-11-11Ch. 1121 Prior Authorization of Anticoagulants—Pharmacy Services 06/08/11 01-11-18
09-11-19
27-11-16
02-11-13
11-11-13
30-11-13
03-11-14
14-11-14
31-11-19
08-11-20
24-11-17
32-11-13Ch. 1121 Prior Authorization of Cymbalta Handbook Pages—
Pharmacy Services06/08/11 01-11-18
09-11-19
27-11-16
02-11-13
11-11-13
30-11-13
03-11-14
14-11-14
31-11-19
08-11-20
24-11-17
32-11-13Ch. 1121 Prior Authorization of Tysabri—Pharmacy Services 06/08/11 01-11-13
09-11-14
27-11-11
02-11-08
11-11-08
30-11-08
03-11-09
14-11-09
31-11-14
08-11-15
24-11-12
32-11-08Ch. 1121 Prior Authorization of Xolair—Pharmacy Services 06/08/11 01-11-15
09-11-16
27-11-13
02-11-10
11-11-10
30-11-10
03-11-11
14-11-11
31-11-16
08-11-17
24-11-14
32-11-10Ch. 1121 Compounded Hydroxyprogesterone Caproate (17-P)—
Pharmacy Services06/08/11 01-11-19
09-11-20
27-11-17
02-11-14
11-11-14
30-11-14
03-11-15
14-11-15
31-11-20
08-11-21
24-11-18
32-11-14Ch. 1121 Prior Authorization of Duplicate Therapy—Pharmacy Services 06/08/11 01-11-20
09-11-21
27-11-18
02-11-15Ch. 1121 Prior Authorization of Makena—Pharmacy Services 06/21/11 01-11-11
09-11-12
27-11-09
02-11-06
11-11-06
30-11-06
03-11-07
14-11-07
31-11-12
08-11-13
24-11-10
32-11-06Ch. 1121 Prior Authorization of Nuedexta—Pharmacy Services 06/21/11 01-11-12
09-11-13
27-11-10
02-11-07
11-11-07
30-11-07
03-11-08
14-11-08
31-11-12
08-11-14
24-11-11
32-11-07Ch. 1121 Anticoagulants Handbook Pages—Pharmacy Services 07/14/11 01-11-40
09-11-41
27-11-38
02-11-35
11-11-35
30-11-35
03-11-36
14-11-36
31-11-41
08-11-42
24-11-11
32-11-35Ch. 1121 Angiotensin Modulators Handbook Pages—Pharmacy Services 07/14/11 01-11-39
09-11-40
27-11-37
02-11-34
11-11-34
30-11-34
03-11-35
14-11-35
31-11-40
08-11-41
24-11-38
32-11-34Ch. 1121 Opiate Dependence Treatments (Formerly Oral Buprenorphine Agents) Handbook Pages—Pharmacy Services 07/14/11 01-11-34
09-11-35
27-11-32
02-11-29
11-11-29
30-11-29
03-11-30
14-11-30
31-11-35
08-11-36
24-11-33
32-11-29Ch. 1121 Bladder Relaxant Preparations Handbook Pages—Pharmacy Services 07/14/11 01-11-14
09-11-25
27-11-22
02-11-19
11-11-19
30-11-19
03-11-20
14-11-20
31-11-25
08-11-26
24-11-23
32-11-19Ch. 1121 Platelet Aggregation Inhibitors Handbook Pages—Pharmacy Services 07/14/11 01-11-38
09-11-39
27-11-36
02-11-33
11-11-33
30-11-33
03-11-34
14-11-34
31-11-39
08-11-40
24-11-37
32-11-33Ch. 1121 Cephalosporins and Related Agents Handbook Pages—
Pharmacy Services07/14/11 01-11-26
09-11-27
27-11-24
02-11-21
11-11-21
30-11-21
03-11-22
14-11-22
31-11-27
08-11-28
24-11-25
32-11-21Ch. 1121 Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Handbook Pages—Pharmacy Services 07/14/11 01-11-29
09-11-30
27-11-27
02-11-24
11-11-24
30-11-24
03-11-25
14-11-25
31-11-30
08-11-31
24-11-28
32-11-24Ch. 1121 Pulmonary Arterial Hypertension Agents, Oral and Inhaled Handbook Pages—Pharmacy Services 07/14/11 01-11-30
09-11-31
27-11-28
02-11-25
11-11-25
30-11-25
03-11-26
14-11-26
31-11-31
08-11-32
24-11-29
32-11-25Ch. 1121 Prior Authorization of Growth Hormones—Pharmacy Services 07/14/11 01-11-42
09-11-43
27-11-40
02-11-37
11-11-37
30-11-37
03-11-38
14-11-38
31-11-43
08-11-44
24-11-41
32-11-25Ch. 1121 Bone Resorption Suppression and Related Agents Handbook Pages—Pharmacy Services 07/14/11 01-11-32
09-11-33
27-11-30
02-11-27
11-11-27
30-11-27
03-11-28
14-11-28
31-11-33
08-11-34
24-11-31
32-11-27Ch. 1121 Multiple Sclerosis Agents Handbook Pages—Pharmacy Services 07/14/11 01-11-41
09-11-42
27-11-39
02-11-36
11-11-36
30-11-36
03-11-37
14-11-37
31-11-42
08-11-43
24-11-40
32-11-36Ch. 1121 Preferred Drug List (PDL) Update August 2011—Pharmacy Services 07/14/11 01-11-37
09-11-38
27-11-35
02-11-32
11-11-32
30-11-32
03-11-33
14-11-33
31-11-38
08-11-39
24-11-36
32-11-32Ch. 1121 Preferred Drug List (PDL) Update August 2011—Pharmacy Services 07/14/11 01-11-35
09-11-36
27-11-33
02-11-30
11-11-30
30-11-30
03-11-31
14-11-31
31-11-36
08-11-37
24-11-34
32-11-32Ch. 1121 Phosphate Binders Handbook Pages—Pharmacy Services 07/14/11 01-11-35
09-11-36
27-11-33
02-11-30
11-11-30
30-11-30
03-11-31
14-11-31
31-11-36
08-11-37
24-11-36
32-11-30Ch. 1121 Analgesics, Narcotics Short Acting Handbook Pages—
Pharmacy Services07/14/11 01-11-23
09-11-24
27-11-21
02-11-18
11-11-18
30-11-18
03-11-19
14-11-19
31-11-24
08-11-25
24-11-22
32-11-18Ch. 1121 Angiotensin Modulator Combinations Handbook Pages—
Pharmacy Services07/14/11 01-11-31
09-11-32
27-11-29
02-11-26
11-11-26
30-11-26
03-11-27
14-11-27
31-11-32
08-11-33
24-11-30
32-11-26Ch. 1121 HIV/AIDS Medications Handbook Pages—Pharmacy Services 07/14/11 01-11-22
09-11-23
27-11-20
02-11-17
11-11-17
30-11-17
03-11-18
14-11-18
31-11-23
08-11-24
24-11-21
32-11-17Ch. 1121 Antifungals, Topical Handbook Pages—Pharmacy Services 07/14/11 01-11-25
09-11-26
27-11-23
02-11-20
11-11-20
30-11-20
03-11-21
14-11-21
31-11-26
08-11-27
24-11-24
32-11-17Ch. 1121 Incretin Memetic/Enhancer Hypoglycemics Handbook Pages—Pharmacy Services 07/14/11 01-11-33
09-11-34
27-11-31
02-11-28
11-11-28
30-11-28
03-11-29
14-11-29
31-11-34
08-11-35
24-11-32
32-11-28Ch. 1121 Oral Contraceptives Handbook Pages—Pharmacy Services 07/14/11 01-11-28
09-11-29
27-11-26
02-11-23
11-11-23
30-11-23
03-11-24
14-11-24
31-11-29
08-11-30
24-11-27
32-11-23Ch. 1121 Prenatal Vitamins Handbook Pages—Pharmacy Services 07/14/11 01-11-36
09-11-37
27-11-34
02-11-31
11-11-31
30-11-31
03-11-32
14-11-32
31-11-87
08-11-38
24-11-35
32-11-31Ch. 1121 Colony Stimulating Factors Handbook Pages—Pharmacy Services 07/14/11 01-11-27
09-11-28
27-11-25
02-11-22
11-11-22
30-11-22
03-11-23
14-11-23
31-11-28
08-11-29
24-11-26
32-11-22Ch. 1121 Antiemetics (Promethazine)—Pharmacy Services 07/19/11 01-11-21
09-11-22
27-11-19
02-11-16
11-11-16
30-11-16
03-11-17
14-11-17
31-11-22
08-11-23
24-11-20
32-11-16Ch. 1121 Correction to Preferred Drug List (PDL) Update August 2011—Pharmacy Services 08/08/11 01-11-45
02-11-39
03-11-40
08-11-46
09-11-45
11-11-39
14-11-40
24-11-46
27-11-42
30-11-39
31-11-44
32-11-39
33-11-07Ch. 1121 Procedures to Submit Requests for Prior Authorization of Selected Medications by Facsimile (Fax)—Pharmacy Services 08/08/11 01-11-46
02-11-40
11-11-40
30-11-40
09-11-46
27-11-43
03-11-41
14-11-41
31-11-45
08-11-47
24-11-47
32-11-40
33-11-08Ch. 1150 2011 HCPCS Updates and Other Procedure Code Changes 08/08/11 00-11-04 Ch. 1101 Provider Screening of Employees and Contractors for Exclusion from Participation in Federal Health Care Programs and the Effect of Exclusion on Participation 08/15/11 99-11-05 Ch. 1121 Prior Authorization of Synagis—Pharmacy Services 08/15/11 01-11-47
09-11-47
27-11-44
02-11-41
11-11-41
30-11-41
03-11-42
14-11-42
31-11-46
08-11-48
24-11-48
32-11-41
33-11-09Ch. 1121 Early Refills—Pharmacy Services 08/15/11 01-11-47
09-11-47
27-11-44
02-11-41
11-11-41
30-11-41
03-11-42
14-11-42
31-11-46
08-11-48
24-11-48
32-11-41
03-11-09— Specialty Pharmacy Drug Program—Updated List of Covered Drugs—Pharmacy Services 09/09/11 99-11-60 Ch. 1149 Medical Assistance Dental Benefit Changes 09/26/11 27-11-47
08-11-51Ch. 1163 Revised Payment Policy for Hospital Readmissions 10/03/11 01-11-44 — Discontinued Mailing of Medical Assistance Bulletins 09/26/11 99-11-08 Ch. 1150 Prudent Payment of Claims 09/30/11 99-11-07 Ch. 1163 Revised Payment Policy for Hospital Readmission 09/30/11 01-11-44 Ch. 1121 Prior Authorization of Stimulants and Related Agents—
Pharmacy Services10/17/11 01-11-48
09-11-48
27-11-45
02-11-42
11-11-42
30-11-42
03-11-43
14-11-43
31-11-47
08-11-49
24-11-49
32-11-42
33-11-10Ch. 1121 Prior Authorization of Xyrem—Pharmacy Services 10/17/11 01-11-49
09-11-49
27-11-46
02-11-43
11-11-43
30-11-43
03-11-44
14-11-44
31-11-48
08-11-50
24-11-50
32-11-43
33-11-11— 5010/D.0 Instructions to be Ready for Electronic Transaction Upgrades 10/27/11 99-11-09 Ch. 1121 Prior Authorization of Benzodiazepines—Pharmacy Services 10/28/11 01-11-50 Ch. 1121 Prior Authorization of Skeletal Muscle Relaxants—
Pharmacy Services10/28/11 01-11-50
09-11-50
27-11-48
02-11-44
11-11-44
30-11-44
03-11-45
14-11-45
31-11-49
08-11-52
24-11-51
32-11-44
33-11-12Ch. 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 Services12/03/11 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 Services01/26/12 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 Services01/26/12 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 Services01/26/12 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 Services01/26/12 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 Services02/01/12 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 Services02/03/12 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 Services02/06/12 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 Services02/13/12 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 Services02/14/12 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 Services03/18/12 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 Services07/13/12 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 Services08/03/12 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 Services08/03/12 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 Services09/13/12 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 Services09/13/12 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 Services 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 Services01/07/13 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 Services01/07/13 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 Services01/22/13 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 Services01/25/13 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 Services03/29/13 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 Services03/29/13 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 Services05/03/13 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 Services05/03/13 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 Services07/13/13 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 Services07/13/13 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 Services07/22/13 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—
Update10/04/13 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 Services12/18/13 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 Services02/03/14 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 Services02/03/14 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 DX05/06/14 01-14-16
08-14-12
09-14-11
28-14-01
31-14-14Ch. 1121 Prior Authorization of Analgesics Narcotic Long Acting—
Pharmacy Services05/30/14 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 Services05/30/14 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 Services05/30/14 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 Services07/07/14 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 Services07/25/14 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 Services07/25/14 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 Services07/25/14 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 Services07/25/14 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 Services08/05/14 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 Services12/29/14 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 Services12/29/14 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 Services02/04/15 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 Services02/18/15 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 Services 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 Services 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 Services05/11/15 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 Services06/25/15 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 Services06/25/15 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 Service07/13/15 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 Schedule 08/10/15 99-15-07
Ch. 1101 1150 Prior Authorization Requirements and Fee Schedule Updates for Hyperbaric Oxygen Therapy 08/31/15 01-15-30
14-15-25
31-15-30
Ch. 1101 1150 2015 HCPCS Updates and Other Procedure Codes 08/31/15 99-15-06 Ch. 1101 1150 Procedure Code Changes for Application of Topical Fluoride Varnish by Physicians and CRNPs 09/01/15 09-15-14
31-15-14
Ch. 1126 112
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 47-15-01Ch. 1121 Specialty Pharmacy Drug Program—Pharmacy Services 08/20/15 99-15-08 Ch. 1101 1150 Medical Assistance (MA) Program's Implementation of ICD-10 Diagnosis and Procedure Code Sets 08/28/15 99-15-09 Ch. 1121 Prior Authorization of Analgesics, Narcotic Long Acting and Analgesics, Narcotic Short Acting—Pharmacy Service 09/04/15 01-15-24
09-15-24 27-15-21 02-15-21
11-15-21 30-15-21 03-15-21 14-15-21 31-15-24 08-15-24 24-15-22 32-15-21 33-15-23Ch. 1121 Prior Authorization of Opiate Dependence Treatments, Oral Buprenorphine Agents—Pharmacy Service 09/04/15 01-15-25
09-15-25 27-15-22 02-15-22
11-15-22 30-15-22 03-15-22 14-15-22 31-15-25 08-15-25 24-15-23 32-15-22 33-15-24Ch. 1241 Implementation of ICD-10 Diagnosis Sets for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Screens 09/14/15 99-15-11 Ch. 1101 1150 New Breast and Cervical Cancer Prevention and Treatment (BCCPT) Program Application for Benefits and Updated ICD-10 Codes 09/21/15 99-15-10 Ch. 1121 Trumenba and Bexsero Meningococcal B Vaccines 10/26/15 01-15-31 08-15-30 09-15-30 31-15-31 33-15-29 Ch. 1121 Prior Authorization of Kalydeco, Nuedexta and Xyrem—
Pharmacy Services11/10/15 01-15-37 02-15-29 03-15-29 08-15-35 09-15-35
11-15-28 14-15-30 24-15-30 27-15-29 30-15-28 31-15-36 32-15-29 33-15-34Ch. 1121 Prior Authorization of Lipotropics, Other—Pharmacy Services 11/13/15 01-15-33 02-15-25 03-15-25 08-15-31 09-15-31
11-15-24 14-15-26 24-15-26 27-15-25 30-15-24 31-15-32 32-15-25 33-15-30Ch. 1121 Prior Authorization of GI Motility, Chronic Agents—
Pharmacy Services11/13/15 01-15-35 02-15-27 03-15-27 08-15-33 09-15-33 11-15-26 14-15-28 24-15-28 27-15-27 30-15-26 31-15-34 32-15-27 33-15-32 Ch. 1121 Prior Authorization of Antibiotics, GI—Pharmacy Services 11/13/15 01-15-36 02-15-28 03-15-28 08-15-34 09-15-34
11-15-27 14-15-29 24-15-29 27-15-28 30-15-27 31-15-35 32-15-28 33-15-33Ch. 1121 Prior Authorization of Angiotensin Modulators—Pharmacy Services 11/18/15 01-15-34 02-15-26 03-15-26 08-15-32 09-15-32
11-15-25 14-15-27 24-15-27 27-15-26 30-15-25 31-15-33 32-15-26 33-15-31Ch. 1163 Revised Procedures for Presumptive Eligibility as Determined by Hospitals 11/30/15 01-15-32 Ch. 1121 Prior Authorization of Corlanor (ivabradine)—Pharmacy Services 11/30/15 01-15-39 09-15-37 27-15-31 02-15-31
11-15-30 30-15-30 03-15-31 14-15-32 31-15-38 08-15-37 24-15-32 32-15-31 33-15-36Ch. 1121 Prior Authorization of Alpha-1 Proteinase Inhibitors—
Pharmacy Services11/30/15 01-15-38 09-15-36 27-15-30 02-15-30
11-15-29 30-15-29 03-15-30 14-15-31 31-15-37 08-15-36 24-15-31 32-15-30 33-15-35Ch. 1127 1141
1221
1225Implementation of ICD-10 Diagnosis Codes for the Family Planning Services Program 11/30/15 01-15-27 08-15-27 09-15-27 24-15-25 25-15-02 28-15-02 31-15-27 33-15-26 Ch. 1121 Prior Authorization of Orkambi (lumacaftor/ivacaftor)—
Pharmacy Services11/30/15 01-15-40 09-15-38 27-15-32 02-15-32
11-15-31 30-15-31 03-15-32 14-15-33 31-15-39 08-15-38 24-15-33 32-15-32 33-15-37Ch. 1101 1150 The Addition of Three-Dimensional (3D) Mammography Procedure Codes to the Medical Assistance Program Fee Schedule 12/09/15 01-15-41 08-15-39 09-15-39 31-15-40 Ch. 1130 1249 Hospice Two-Tiered Routine Home Care and Service Intensity Add-On Payments 12/31/15 06-15-02 09-15-40 31-15-41 Ch. 1121 Preferred Drug List (PDL) Update January 20, 2016—
Pharmacy Services01/08/16 01-16-01 09-16-01 27-16-01 02-16-01
11-16-01 30-16-01 03-16-01 14-16-01 31-16-01 08-16-01 24-16-01 32-16-01 33-16-01Ch. 1121 Prior Authorization of Bile Salts—Pharmacy Services 01/06/16 01-16-02 09-16-02 27-16-02 02-16-02
11-16-02 30-16-02 03-16-02 14-16-02 31-16-02 08-16-02 24-26-02 32-16-02 33-16-02Ch. 1121 Prior Authorization of Methotrexate—Pharmacy Services 01/06/16 01-16-06 09-16-06 27-16-06 02-16-06
11-16-06 30-16-06 03-16-06 14-16-06 31-16-06 08-16-06 24-16-06 32-16-06 33-16-06Ch. 1121 Prior Authorization of Macular Degeneration Agents—
Pharmacy Services01/06/16 01-16-04 09-16-04 27-16-04 02-16-04
11-16-04 30-16-04 03-16-04 14-16-04 31-16-04 08-16-04 24-16-04 32-16-04 33-16-04Ch. 1121 Prior Authorization of COPD Agents—Pharmacy Services 01/06/16 01-16-03 09-16-03 27-16-03 02-16-03
11-16-03 30-16-03 03-16-03 14-16-03 31-16-03 08-16-03 24-16-03 32-16-03 33-16-03Ch. 1121 Prior Authorization of Antipsychotics—Pharmacy Services 01/06/16 01-16-08 09-16-08 27-16-08 02-16-08
11-16-08 30-16-08 03-16-08 14-16-08 31-16-08 08-16-08 24-16-08 32-16-08 33-16-08Ch. 1121 Prior Authorization of Stimulants and Related Agents—
Pharmacy Services01/06/16 01-16-05 09-16-05 27-16-05 02-16-05
11-16-05 30-16-05 03-16-05 14-16-05 31-16-05 08-16-05 24-16-05 32-16-05 33-16-05Ch. 1149 Required Training for the Application of Topical Fluoride Varnish 02/26/16 09-16-10 31-16-10 Ch. 1249 Updates to the Medical Assistance Program Fee Schedule for HHA Nursing Visits 03/10/16 05-06-01 Ch. 1121 Prior Authorization of Anticonvulsants, Oral; Duloxetine Agents; and Neuropathic Pain Agents—Pharmacy Services 03/14/16 01-16-09
09-16-11 27-16-09 02-16-09
11-16-09 30-16-09 03-16-09 14-16-09
31-16-11 08-16-09 24-16-10 32-16-09Ch. 1121 Prior Authorization of Stimulants and Related Agents—
Pharmacy Services03/14/16 01-16-11 09-16-13 27-16-11 02-16-11 11-16-11 30-16-11 03-16-11 14-16-11 31-16-13 08-16-11 24-16-12 32-16-11 33-16-11 Ch. 1121 Prior Authorization of Lipotropics, Other—Pharmacy Services 03/14/16 01-16-10 09-16-12 27-16-10 02-16-10 11-16-10 30-16-10 03-16-10 14-16-10 31-16-12 08-16-10 24-16-11 32-16-10 33-16-10 Ch. 1140 Updates to the Medical Assistance Program Fee Schedule For Healthy Beginnings Plus 03/18/16 01-16-12 05-16-02 08-16-12 31-16-14 33-16-12 47-16-01 Ch. 1101 Enrollment of Ordering, Referring and Prescribing Providers 04/01/16 99-16-07 Ch. 1150 Procedure for Obtaining an 1150 Administrative Waiver for Durable Medical Equipment, Medical Supplies or Prosthetics and Orthotics 04/19/16 09-16-09 24-16-09 25-16-01 31-16-09 Ch. 1101 Revalidation of Medical Assistance (MA) Providers 05/26/16 99-16-10 Ch. 1101 Enrollment of Co-Located Providers 05/31/16 99-16-04 Ch. 1121 Prior Authorization of Provenge (sipuleucel-T)—Pharmacy Services 06/13/16 01-16-17 09-16-16 27-16-15 02-16-15 11-16-115 30-16-15 03-16-15 14-16-15 31-16-18 08-16-16 24-16-16 32-16-14 33-16-15 Ch. 1121 Prior Authorization of Antihyperuricemics—Pharmacy Services 06/13/16 01-16-15 09-16-14 27-16-13 02-16-13 11-16-13 30-16-13 03-16-13 14-16-13 31-16-16 08-16-14 24-16-14 32-16-12 33-16-13 Ch. 1121 Prior Authorization of Xofigo (radium Ra 223 dichloride)—
Pharmacy Services06/13/16 01-16-18 09-16-17 27-16-16 02-16-16 11-16-16 30-16-16 14-16-16 31-16-19 08-16-17 24-16-17 32-16-15 33-16-16 Ch. 1123 Ch. 1249 Face-to-Face Encounter Requirements for Prescribing of Home Health Services Including Durable Medical Equipment and Medical Supplies 06/27/16 05-16-04 24-16-18 25-16-03 31-16-21 Ch. 1101 2016 Healthcare Common Procedure Coding System (HCPCS) Updates and Other Procedure Code Changes 06/27/16 99-16-08 Ch. 1150 Observation Services 06/27/16 01-16-19 14-16-17 27-16-17 31-16-20 Ch. 1121 Prior Authorization of Hereditary Angioedema (HAE) Agents—Pharmacy Services 07/05/16 01-16-22 09-16-20 27-16-20 02-16-19 11-16-19 30-16-19 03-16-19 14-16-20 31-16-24 08-16-20 24-16-22 32-16-18 33-16-19 Ch. 1121 Prior Authorization of Anticoagulants—Pharmacy Services 07/05/16 01-16-20 09-16-18 27-16-18 02-16-17 11-16-17 30-16-17 03-16-18 14-16-18 31-16-22 08-16-18 24-16-20 32-16-16 33-16-17 Ch. 1121 Prior Authorization of Cephalosporins and Related Agents—
Pharmacy Services07/05/16 01-16-28 09-16-26 27-16-26 02-16-25 11-16-25 30-16-25 03-16-25 14-16-26 31-16-30 08-16-26 24-16-28 32-16-24 33-16-25 Ch. 1121 Preferred Drug List (PDL) Update July 18, 2016—Pharmacy Services 07/05/16 01-16-26 09-16-24 27-16-24 02-16-23 11-16-23 30-16-23 03-16-23 14-16-24 31-16-28 08-16-24 24-16-26 32-16-22 33-16-23 Ch. 1121 Prior Authorization of Antifungals, Topical—Pharmacy Services 07/05/16 01-16-21 09-16-19 27-16-19 02-16-18 11-16-18 30-16-18 03-16-18 14-16-19 31-16-23 08-16-19 24-16-21 32-16-17 33-16-18 Ch. 1121 Prior Authorization of Tetracyclines—Pharmacy Services 07/05/16 01-16-25 09-16-23 27-16-23 02-16-22 11-16-22 30-16-22 03-16-22 14-16-23 31-16-27 08-16-23 24-16-25 32-16-21 33-16-22 Ch. 1121 Prior Authorization of Opiate Overdose Agents—Pharmacy Services 07/07/16 01-16-27 09-16-25 27-16-25 02-16-24 11-16-24 30-16-24 03-16-24 14-16-25 31-16-29 08-16-25 24-16-24 32-16-23 33-16-24 Ch. 1121 Prior Authorization of Lipotropics, Other—Pharmacy Services 07/08/16 01-16-24 02-16-21 03-16-21 08-16-22 09-16-22 11-16-21 14-16-22 24-16-24 27-16-22 30-16-21 31-16-26 32-16-20 33-16-21 Ch. 1101 Federal Final Rule, ''Nondiscrimination in Health Programs and Activities'' and Implication for Coverage of Services Related Gender Transition 07/18/16 99-16-11 Ch. 1121 Coverage for Mosquito Repellants 07/18/16 99-16-14 Ch. 1101 Enrollment of Physician Assistants Who Order, Refer and Prescribe for Medical Assistance Beneficiaries 08/03/16 10-16-01 Ch. 1101 Assignment of ACA Categorical Risk Levels and Implementation of Site Visits 08/04/16 99-16-13 Ch. 1101 Electronic Provider Enrollment Application 08/08/16 99-16-12 Ch. 1150 Payment of Claims for Services Provided to Children and Adolescents for the Diagnostic Assessment and Treatment of Autism Spectrum Disorder 08/17/16 99-16-15 Ch. 1150 1249 Medical Assistance Program Fee Increases For Private Duty/Shift Nursing Services to MA Beneficiaries Under 21 Years of Age 08/26/16 05-16-05 16-16-01 Ch. 1121 Prior Authorization of Incretin Mimetic/Enhancer Hypoglycemics—Pharmacy Services 09/30/16 01-16-30 09-16-28 27-16-27 02-16-26 11-16-26 30-16-26 03-16-26 14-16-27 31-16-32 08-16-28 24-16-29 32-16-25 33-16-27 Ch. 1121 Prior Authorization of Botulinum Toxins—Pharmacy Services 10/20/16 01-16-31 09-16-29 27-16-28 02-16-27 11-16-27 30-16-27 03-16-27 14-16-28 31-16-33 08-16-29 24-16-30 32-16-26 33-16-28 Ch. 1101 Services Ordered, Referred, or Prescribed By Graduate Medical or Osteopathic Trainees 11/02/16 01-16-32 31-16-34 Ch. 1101 1225 MA Program Fee Schedule Updates for Certain Family Planning Services 11/26/16 01-16-33 08-16-31 09-16-30 28-16-02 31-16-35 33-16-29 Ch. 1101 1150, 1121 Federally Qualified Health Center Alternative Payment Methodologies for Delivery Services 11/28/16 08-16-30 Ch. 1121 Addition to the Medical Assistance Program Fee Schedule for Administration of Quadrivalent Flu Vaccine Derived from Cell Cultures 12/23/16 01-17-01 08-17-01 09-17-01 31-17-01 33-17-01 Ch. 1121 Prior Authorization of Opiate Dependence Treatments—
Pharmacy Services01/04/17 01-17-02 02-17-01 03-17-01 08-17-02 09-17-02 11-17-01 14-17-01 24-17-01 27-17-01 30-17-02 31-17-03 32-17-01 33-17-02 Ch. 1101 1150 Submission of Claims that Require the National Provider Identifier (NPI) of the Ordering, Referring or Prescribing Provider 01/30/17 99-17-02 Ch. 1121 Prior Authorization of Anitparkinson's Agents—Pharmacy Services 01/30/17 01-17-06 09-17-05 27-17-04 02-17-04 11-17-04 30-17-05 03-17-04 14-17-04 31-17-06 08-17-05 24-17-04 32-17-04 33-17-05 Ch. 1121 Prior Authorization of Botulinum Toxins—Pharmacy Services 01/30/17 01-17-09 09-17-08 27-17-07 02-17-07 11-17-07 30-17-08 03-17-07 14-17-07 31-17-09 08-17-08 24-17-07 32-17-07 33-17-08 Ch. 1121 Prior Authorization of Bronchodilators, Beta Agonists—
Pharmacy Services01/30/17 01-17-10 09-17-09 27-17-08 02-17-08 11-17-08 30-17-09 03-17-08 14-17-08 31-17-10 08-17-09 24-17-08 32-17-08 33-17-09 Ch. 1121 Prior Authorization of Cytokine and CAM Antagonists—
Pharmacy Services01/30/17 01-17-11 02-17-09 03-17-09 08-17-10 09-17-10 11-17-09 14-17-09 24-17-09 27-17-09 30-17-10 31-17-11 32-17-09 33-17-10 Ch. 1121 Prior Authorization of Analgesics, Narcotic Long Acting and Analgesics, Narcotic Short Acting—Pharmacy Services 01/31/17 01-17-04 09-17-03 27-17-02 02-17-02 11-17-02 30-17-03 03-17-02 14-17-02 31-17-04 08-17-03 24-17-02 32-17-02 33-17-03 Ch. 1121 Prior Authorization of Analgesics, Non-Narcotic Barbiturate Combinations—Pharmacy Services 01/31/17 01-17-05 09-17-04 27-17-03 02-17-03 11-17-03 30-17-04 03-17-03 14-17-03 31-17-05 08-17-04 24-17-03 32-17-03 33-17-04 Ch. 1121 Prior Authorization of Anxiolytics—Pharmacy Services 01/31/17 01-17-07 09-17-06 27-17-05 02-17-05 11-17-05 30-17-06 03-17-05 14-17-05 31-17-07 08-17-06 24-17-05 32-17-05 33-17-06 Ch. 1121 Prior Authorization of Bile Salts—Pharmacy Services 01/31/17 01-17-08 09-17-07 27-17-06 02-17-06 11-17-06 30-17-07 03-17-06 14-17-06 31-17-08 08-17-07 24-17-06 32-17-06 33-17-07 Ch. 1121 Prior Authorization of Nplate (romiplostim)—Pharmacy Services 01/31/17 01-17-12 02-17-10 03-17-10 08-17-11 09-17-11 11-17-10 14-17-10 24-17-10 27-17-10 30-17-11 31-17-12 32-17-10 33-17-11 Ch. 1121 Prior Authorization of Pituitary Suppressive Agents, LHRH—Pharmacy Services 01/31/17 01-17-13 02-17-11 03-17-11 08-17-12 09-17-12 11-17-11 14-17-11 24-17-11 27-17-11 30-17-12 31-17-13 32-17-11 33-17-12 Ch. 1121 Prior Authorization of Promacta (eltrombopag)—Pharmacy Services 01/31/17 01-17-14 02-17-12 03-17-12 08-17-13 09-17-13 11-17-12 14-17-12 24-17-12 27-17-12 30-17-13 31-17-14 32-17-12 33-17-13 Ch. 1121 Prior Authorization of Sedative Hypnotics—Pharmacy Services 01/31/17 01-17-15 02-17-13 03-17-13 08-17-14 09-17-14 11-17-13 14-17-13 24-17-13 27-17-13 30-17-14 31-17-15 32-17-13 33-17-14 Ch. 1121 Prior Authorization of Stimulants and Related Agents—
Pharmacy Services01/31/17 01-17-16 02-17-14 03-17-14 08-17-15 09-17-15 11-17-14 14-17-14 24-17-14 27-17-14 30-17-15 31-17-16 32-17-14 33-17-15 Ch. 1121 Prior Authorization of Xyrem (sodium oxybate)—Pharmacy Services 01/31/17 01-17-17 02-17-15 03-17-15 08-17-16 09-17-16 11-17-15 14-17-15 24-17-15 27-17-15 30-17-16 31-17-17 32-17-15 33-17-16 Ch. 1101 School-Based ACCESS Program Provider Handbook 02/28/17 35-17-01 Ch. 1101 Implementation of Criminal Background Checks for Providers Assigned ACA Categorical Risk Level of High 03/06/17 99-17-03 Ch. 1241 2017 Recommended Childhood and Adolescent Immunization Schedules 04/24/17 99-17-04 Ch. 1121 Prior Authorization of Xolair (omalizumab)—Pharmacy Services 04/27/17 01-17-18 02-17-16 03-17-16 08-17-18 09-17-17 11-17-16 14-17-16 24-17-16 27-17-16 30-17-17 31-17-18 32-17-16 33-17-17 Ch. 1121 Prior Authorization of Ophthalmic Immunomodulators—
Pharmacy Services04/27/17 01-17-19 02-17-17 03-17-17 08-17-19 09-17-18 11-17-17 14-17-17 24-17-17 27-17-17 30-17-18 31-17-19 32-17-17 33-17-18 Ch. 1121 Prior Authorization of Cytokine and CAM Antagonists—
Pharmacy Services04/27/17 01-17-21 02-17-19 03-17-19 08-17-21 09-17-20 11-17-19 14-17-19 24-17-19 27-17-19 30-17-20 31-17-21 32-17-19 33-17-20 Ch. 1129 Opt-In Procedures for Federally Qualified Health Centers and Rural Health Clinics to Receive the Prospective Payment System Rate from Managed Care Organizations 05/30/17 07-17-01 08-17-22 Ch. 1101 Discontinuance of Federally Qualified Health Center Alternative Payment Methodology for Delivery Services in the Federally Qualified Health Center Setting 05/30/17 08/17/17 Ch. 1121 Prior Authorization of Analgesics, Narcotic Long Acting and Analgesics, Narcotic Short Acting—Pharmacy Services 06/07/17 01-17-22 02-17-20 03-17-20 08-17-23 09-17-21 11-17-20 14-17-20 24-17-20 27-17-20 30-17-21 31-17-22 32-17-20 33-17-21 Ch. 1121 Prior Authorization of Cinqair (reslizumab)—Pharmacy Services 06/07/17 01-17-23 02-17-21 03-17-21 08-17-24 09-17-22 11-17-21 14-17-21 24-17-21 27-17-21 30-17-22 31-17-23 32-17-21 33-17-22 Ch. 1121 Prior Authorization of Exondys 51 (eteplirsen)—Pharmacy Services 06/07/17 01-17-24 02-17-22 03-17-22 08-17-25 09-17-23 11-17-22 14-17-22 24-17-22 27-17-22 30-17-23 31-17-24 32-17-22 33-17-23 Ch. 1121 Prior Authorization of Multiple Sclerosis Agents—Pharmacy Services 06/07/17 01-17-25 09-17-24 27-17-23 02-17-23 11-17-23 30-17-24 03-17-23 14-17-23 31-17-25 08-17-26 24-17-23 32-17-23 33-17-24 Ch. 1121 Prior Authorization of Oncology Agents, Breast Cancer—
Pharmacy Services06/07/17 01-17-26 02-17-24 03-17-24 08-17-27 09-17-25 11-17-24 14-17-24 24-17-24 27-17-24 30-17-25 31-17-26 32-17-24 33-17-25 Ch. 1121 Prior Authorization of Spinraza (nusinersen)—Pharmacy Services 06/07/17 01-17-27 02-17-25 03-17-25 08-17-28 09-17-26 11-17-25 14-17-25 24-17-25 27-17-25 30-17-26 31-17-27 32-17-25 33-17-26 Ch. 1101 Updates to the Medical Assistance Copayment Desk Reference 06/26/17 99-17-06 Ch. 1121 Prior Authorization of Hepatitis C Agents—Pharmacy Services 06/28/17 01-17-30 02-17-26 03-17-26 08-17-32 09-17-28 11-17-26 14-17-26 24-17-27 27-17-27 30-17-27 31-17-30 32-17-26 33-17-29 Ch. 1121 Payment for Covered Outpatient Drugs—Pharmacy Services 06/28/17 99-17-09 Ch. 1121 Prior Authorization of Angiotensin Modulators—Pharmacy Services 07/13/17 01-17-34 09-17-32 27-17-30 02-17-29 11-17-29 30-17-30 03-17-29 14-17-29 31-17-34 08-17-35 24-17-30 32-17-29 33-17-33 Ch. 1121 Preferred Drug List (PDL) Update July 25, 2017—Pharmacy Services 07/21/17 01-17-32 02-17-27 03-17-27 08-17-33 09-17-30 11-17-27 14-17-27 24-17-27 27-17-28 30-17-28 31-17-32 32-17-27 33-17-31 Ch. 1149 Public Health Dental Hygiene Practitioner Enrollment in the Medical Assistance Program 08/01/17 08-17-31 10-17-01 27-17-26 Ch. 1241 Revisions to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule 08/07/17 99-17-10 Ch. 1101 1150 2017 Healthcare Common Procedure Coding System (HCPCS) Updates and Other Procedure Code Changes 08/07/17 99-17-08 Ch. 1101 1150 Pasteurized Donor Human Milk 08/07/17 01-17-31 09-17-29 25-17-02 31-17-31 33-17-30 Ch. 1101 1150, 1225 MA Program Fee Schedule Updates for Certain Family Planning Services 08/07/17 01-17-29 08-17-29 09-17-27 24-17-26 25-17-01 28-17-01 31-17-28 33-17-27 Ch. 1101 1150 Procedure Code Change for Tobacco Cessation Counseling Services 08/07/17 99-17-07 Ch. 1121 Prior Authorization of Intra-Articular Hyaluronates—Pharmacy Services 08/08/17 01-17-33 02-17-28 03-17-28 08-17-34 09-17-31 11-17-28 14-17-28 24-17-29 27-17-29 30-17-29 31-17-33 32-17-28 33-17-32 Ch. 1127 1143
1163''Newborn Add'' Feature for COMPASS 08/09/17 01-17-28 33-17-28 47-17-01 Ch. 1101 Limited English Proficiency Requirements 08/11/17 99-17-11 Ch. 1101 School-Based ACCESS Program Provider Handbook 11/22/17 35-17-02 Ch. 1121 Prior Authorization of Antibiotics, GI and Related Agents—Pharmacy Services 12/14/17 01-17-35 02-17-30 03-17-30 08-17-37 09-17-34 11-17-30 14-17-31 24-17-31 27-17-32 30-17-31 31-17-36 32-17-30 33-17-35 Ch. 1121 Prior Authorization of Analgesics, Opioid Long Acting—
Pharmacy Services12/27/17 01-17-36 02-17-31 03-17-31 08-17-37 09-17-35 11-17-31 14-17-32 24-17-32 27-17-33 30-17-32 31-17-37 32-17-31 33-17-36 Ch. 1121 Prior Authorization of Xermelo (telotristat ethyl)—Pharmacy Services 12/27/17 01-17-44 02-17-39 03-17-39 08-17-46 09-17-43 11-17-39 14-17-40 24-17-40 27-17-41 30-17-40 31-17-45 32-17-39 33-17-44 Ch. 1121 Prior Authorization of Austedo (deutetrabenazine)—Pharmacy Services 12/27/17 01-17-40 02-17-35 03-17-35 08-17-42 09-17-39 11-17-35 14-17-36 24-17-36 27-17-37 30-17-36 31-17-41 32-17-35 33-17-40 Ch. 1121 Prior Authorization of Multiple Sclerosis Agents—Pharmacy Services 12/27/17 01-17-38 02-17-33 03-17-33 08-17-40 09-17-37 11-17-33 14-17-34 24-17-34 27-17-35 30-17-34 31-17-39 32-17-33 33-17-38 Ch. 1121 Prior Authorization of Ingrezza (valbenazine)—Pharmacy Services 12/27/17 01-17-39 02-17-34 03-17-34 08-17-41 09-17-38 11-17-34 14-17-35 24-17-35 27-17-36 30-17-35 31-17-40 32-17-34 33-17-39 Ch. 1121 Prior Authorization of Brineura (cerliponase alfa)—
Pharmacy Services12/27/17 01-17-41 02-17-36 03-17-36 08-17-43 09-17-40 11-17-36 14-17-37 24-17-37 27-17-38 30-17-37 31-17-42 32-17-36 33-17-41 Ch. 1121 Prior Authorization of Analgesics, Opioid Short Acting—
Pharmacy Services12/14/17 01-17-37 02-17-32 03-17-32 08-17-39 09-17-36 11-17-32 14-17-33 24-17-33 27-17-34 30-17-33 31-17-38 32-17-32 33-17-37 Ch. 1163 Hospital Responsibilities Related to the Uncompensated Care Program and Charity Care Plans 12/27/17 01-17-03 Ch. 1121 Prior Authorization of Xenazine (tetrabenazine)—Pharmacy Services 12/27/17 01-17-45 02-17-40 03-17-40 08-17-47 09-17-44 11-17-40 14-17-41 24-17-41 27-17-42 30-17-41 31-17-46 32-17-40 33-17-45 Ch. 1121 Prior Authorization of Bone Resorption Suppression and Related Agents—Pharmacy Services 12/27/17 01-17-42 02-17-37 03-17-37 08-17-44 09-17-41 11-17-37 14-17-38 24-17-38 27-17-39 30-17-38 31-17-43 32-17-37 33-17-42 Ch. 1121 Prior Authorization of Cytokine and CAM Antagonists—
Pharmacy Services12/27/17 01-17-46 02-17-41 03-17-41 08-17-48 09-17-45 11-17-41 14-17-42 24-17-42 27-17-43 30-17-42 31-17-47 32-17-41 33-17-46 2018 Ch. 1101 1150 Revised Health Care Benefit Packages Provider Reference Chart (MA 446) 01/02/18 99-18-01 Ch. 1241 Updates to the 2017 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule 01/03/18 99-18-02 Ch. 1121 Preferred Drug List (PDL) Update January 8, 2018—
Pharmacy Services01/08/18 01-18-01 02-18-01 03-18-01 08-18-01 09-18-01 11-18-01 14-18-01 24-18-01 27-18-01 30-18-01 31-18-01 32-18-01 33-18-01 Ch. 1121 Corrected—Prior Authorization of Hepatitis C Agents—
Pharmacy Services01/22/18 01-18-04 02-18-02 03-18-02 08-18-04 09-18-04 11-18-02 14-18-02 24-18-02 27-18-03 30-18-02 31-18-04 32-18-02 33-18-04 Ch. 1101 1150 Acupuncturist Enrollment in the Medical Assistance Program 02/21/18 08-18-05 09-18-05 10-18-01 14-18-03 27-18-04 31-18-05 33-18-05 Ch. 1141 1142
1149
1221
1243Clinical Laboratory Improvement Amendments Excluded Laboratory Services Update 02/26/18 01-18-03 08-18-03 09-18-03 27-18-02 28-18-01 31-18-03 33-18-03 Ch. 1221 Addition to the Medical Assistance Program Fee Schedule for Administration of Quadrivalent Flu Vaccine Derived from Cell Cultures, Preservative 03/5/18 01-18-02 08-18-02 09-18-02 31-18-02 33-18-02 Ch. 1101 School-Based ACCESS Program Provider Handbook 03/14/18 35-18-01 Ch. 1221 Prior Authorization of Opioid Dependence Treatments—Pharmacy Services 04/10/18 01-18-06 02-18-04 03-18-04 08-18-07 09-18-07 11-18-04 14-18-05 24-18-04 27-18-06 30-18-04 31-18-07 32-18-04 33-18-07 Ch. 1101 1121, 1150 Update to Submission of Claims that Require the National Provider Identifier (NPI) of a Medical Assistance Enrolled Ordering, Referring or Prescribing Provider 04/16/18 99-18-06 Ch. 1121 Prior Authorization of Analgesics, Opioid Long Acting—
Pharmacy Services04/26/18 01-18-07 09-18-08 27-18-07 33-18-08 02-18-05 11-18-05 30-18-05 03-18-05 14-18-06 31-18-08 08-18-08 24-18-05 32-18-05 Ch. 1121 Prior Authorization of Analgesics, Opioid Short Acting—
Pharmacy Services04/26/18 01-18-05 09-18-06 27-18-05 33-18-06 02-18-03 11-18-03 30-18-03 03-18-03 14-18-04 31-18-06 08-18-06 24-18-03 32-18-03 Ch. 1241 2018 Recommended Childhood and Adolescent Immunization Schedule 04/27/18 99-18-05 Ch. 1101 1150 Update to 180-Day Exception Requests and Invoice Submission Time Frames 05/25/18 99-18-08 Ch. 1101 Reduction of Mailed Paper Remittance Advices 06/15/18 99-18-09 Ch. 1101 1150 Enrollment of Tobacco Cessation Providers 06/18/18 99-18-10 Ch. 1101 1150 2018 Healthcare Common Procedure Coding System (HCPCS) Updates and Other Procedure Code Changes 07/02/18 99-18-07 Ch. 1149 Medical Assistance Program Dental Fee Schedule Update 07/02/18 27-18-08 Ch. 1127 1142
1144
1221
1252Updates to the Family Planning Services Program Fee Schedule 07/02/18 01-18-08 08-18-09 09-18-09 24-18-06 25-18-01 28-18-02 31-18-09 33-18-09 Ch. 1149 1241 Updates to the Pediatric Dental Periodicity Schedule 07/03/18 27-18-09 Ch. 1141 1144
1225
1241Childhood Nutrition and Weight Management Services 07/03/18 01-18-09 08-18-10 09-18-10 16-18-01 23-18-01 31-18-10 Ch. 1121 Preferred Drug List (PDL) Update July 23, 2018—Pharmacy Services 07/18/18 01-18-11 02-18-06 03-18-06 08-18-13 09-18-12 11-18-06 14-18-07 24-18-07 27-18-10 30-18-06 31-18-12 32-18-06 33-18-11 Ch. 1121 Prior Authorization of Thalidomide and Derivatives—
Pharmacy Services07/23/18 01-18-23 02-18-18 03-18-18 08-18-25 09-18-24 11-18-18 14-18-19 24-18-19 27-18-22 30-18-18 31-18-24 32-18-18 33-18-23 Ch. 1121 Prior Authorization of VMAT2 Inhibitors—Pharmacy Services 07/23/18 01-18-17 02-18-12 03-18-12 08-18-19 09-18-18 11-18-12 14-18-13 24-18-13 27-18-16 30-18-12 31-18-18 32-18-12 33-18-17 Ch. 1121 Prior Authorization of Oncology Agents, Oral—Pharmacy Services 07/23/18 01-18-22 02-18-17 03-18-17 08-18-24 09-18-23 11-18-17 14-18-18 24-18-18 27-18-21 30-18-17 31-18-23 32-18-17 33-18-22 Ch. 1121 Prior Authorization of Immunomodulators, Atopic Dermatitis—Pharmacy Services 07/23/18 01-18-13 02-18-08 03-18-08 08-18-15 09-18-14 11-18-08 14-18-09 24-18-09 27-18-12 30-18-08 31-18-14 32-18-08 33-18-13 Ch. 1121 Prior Authorization of Enzyme Replacements, Gauchers Disease—Pharmacy Services 07/23/18 01-18-20 02-18-15 03-18-15 08-18-22 09-18-21 11-18-15 14-18-16 24-18-16 27-18-19 30-18-15 31-18-21 32-18-15 33-18-20 Ch. 1121 Prior Authorization of Neuropathic Pain Agents—Pharmacy Services 07/23/18 01-18-16 02-18-11 03-18-11 08-18-18 09-18-17 11-18-11 14-18-12 24-18-12 27-18-15 30-18-11 31-18-17 32-18-11 33-18-16 Ch. 1121 Prior Authorization of Lipotropics, Other—Pharmacy Services 07/23/18 01-18-14 02-18-09 03-18-09 08-18-16 09-18-15 11-18-09 14-18-10 24-18-10 27-18-13 30-18-09 31-18-15 32-18-09 33-18-14 Ch. 1121 Prior Authorization of Idiopathic Pulmonary Fibrosis (IPF) Agents—Pharmacy Services 07/23/18 01-18-21 02-18-16 03-18-16 08-18-23 09-18-22 11-18-16 14-18-17 24-18-17 27-18-20 30-18-16 31-18-22 32-18-16 33-18-21 Ch. 1121 Prior Authorization of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)—Pharmacy Services 07/23/18 01-18-18 02-18-13 03-18-13 08-18-20 09-18-19 11-18-13 14-18-14 24-18-14 27-18-17 30-18-13 31-18-19 32-18-13 33-18-18 Ch. 1121 Prior Authorization of Monoclonal Antibodies—Anti-IL, Anti-IgE (MABs-Anti-IL, Anti-IgE)—Pharmacy Services 07/23/18 01-18-15 02-18-10 03-18-10 08-18-17 09-18-16 11-18-10 14-18-11 24-18-11 27-18-14 30-18-13 31-18-19 32-18-13 33-18-18 Ch. 1121 Prior Authorization of Analgesics, Non-Opioid Barbiturate Combinations—Pharmacy Services 07/23/18 01-18-12 02-18-07 03-18-07 08-18-14 09-18-13 11-18-07 14-18-08 24-18-08 27-18-11 30-18-07 31-18-13 32-18-07 33-18-12 Ch. 1121 Prior Authorization of Bone Resorption Suppression and Related Agents—Pharmacy Services 07/23/18 01-18-19 02-18-14 03-18-14 08-18-21 09-18-13 11-18-07 14-18-08 24-18-08 27-18-11 30-18-07 31-18-13 32-18-07 33-18-12 Ch. 1241 Updates to Pennsylvania's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule 08/01/18 99-18-13 Ch. 1121 Prior Authorization of Multiple Sclerosis Agents—Pharmacy Services 08/13/18 01-18-24 Ch. 1241 Environmental Lead Investigations 08/22/18 01-18-10 08-18-11 09-18-11 31-18-11 33-18-10 55-18-01 Ch. 1101 School-Based ACCESS Program Provider Handbook 09/19/18 35-18-02 Ch. 1121 Professional Dispensing Fee—Pharmacy Services 10/04/18 35-18-02 Ch. 1187 1189 Changes to Managed Care Coverage of Nursing Facility Services 11/21/18 03-18-20 Ch. 1121 Prior Authorization of Antimigraine Agents—Pharmacy Services 12/12/18 01-18-27 02-18-22 03-18-23 08-18-30 09-18-28 11-18-22 14-18-23 24-18-24 27-18-27 30-18-22 31-18-28 32-18-22 33-18-27 Ch. 1121 Prior Authorization of Angiotensin Modulators—Pharmacy Services 12/12/18 01-18-26 02-18-21 03-18-22 08-18-29 09-18-27 11-18-21 14-18-22 24-18-23 27-18-26 30-18-21 31-18-27 32-18-21 33-18-26 Ch. 1121 Prior Authorization of Angiotensin Modulator Combinations—Pharmacy Services 12/12/18 01-18-25 02-18-20 03-18-24 08-18-28 09-18-26 11-18-20 14-18-21 24-18-22 27-18-25 30-18-20 31-18-26 32-18-20 33-18-25 Ch. 1121 Prior Authorization of Hepatitis C Agents—Pharmacy Services 12/12/18 01-18-28 02-18-23 03-18-24 08-18-31 09-18-29 11-18-23 14-18-24 24-18-25 27-18-28 30-18-23 31-18-29 32-18-23 33-18-28 Ch. 1121 Prior Authorization of Antibiotics, GI and Related Agents—
Pharmacy Services12/12/18 01-18-36 02-18-31 03-18-32 08-18-39 09-18-37 11-18-31 14-18-32 24-18-33 27-18-36 30-18-31 31-18-37 32-18-31 33-18-36 Ch. 1121 Prior Authorization of Hypoglycemics, Insulin and Related Agents—Pharmacy Services 12/13/18 01-18-30 02-18-25 03-18-26 08-18-33 09-18-31 11-18-25 14-18-26 24-18-27 27-18-30 30-18-25 31-18-31 32-18-25 33-18-30 Ch. 1121 Prior Authorization of Hypoglycemics, TZDs—Pharmacy Services 12/13/18 01-18-33 02-18-28 03-18-29 08-18-36 09-18-34 11-18-28 14-18-29 24-18-30 27-18-33 30-18-28 31-18-34 32-18-28 33-18-33 Ch. 1121 Prior Authorization of Hypoglycemics, SGLT2 Inhibitors—
Pharmacy Services12/13/18 01-18-31 02-18-26 03-18-27 08-18-34 09-18-32 11-18-26 14-18-27 24-18-28 27-18-31 30-18-26 31-18-32 32-18-26 33-18-31 Ch. 1121 Prior Authorization of Hypoglycemics, Incretin Mimetics/Enhancers—Pharmacy Services 12/13/2018 01-18-29 02-18-24 03-18-25 08-18-32 09-18-30 11-18-24 14-18-25 24-18-26 27-18-29 30-18-24 31-18-30 32-18-24 33-18-29 Ch. 1121 Prior Authorization of Oncology Agents, Oral—Pharmacy Services 12/13/18 01-18-34 02-18-29 03-18-30 08-18-37 09-18-35 11-18-29 14-18-30 24-18-31 27-18-34 30-18-29 31-18-35 32-18-29 33-18-34 Ch. 1121 Prior Authorization of Kalydeco (ivacaftor)—Pharmacy Services 12/13/18 01-18-32 02-18-27 03-18-28 08-18-35 09-18-33 11-18-27 14-18-28 24-18-29 27-18-32 30-18-27 31-18-33 32-18-27 33-18-32 Ch. 1121 Prior Authorization of Orkambi (lumacaftor/ivacaftor)—
Pharmacy Services12/13/18 01-18-35 02-18-30 03-18-31 08-18-38 09-18-36 11-18-30 14-18-31 24-18-32 27-18-35 30-18-30 31-18-36 32-18-30 33-18-35 Ch. 1101 Service Location Enrollment Deadline 12/19/18 99-18-11 Ch. 1245 Fee Increases for Certain Ambulance Transportation Services 12/24/18 26-18-01 2019 Ch. 1243 Updates to Laboratory Services on the Medical Assistance Program Fee Schedule; Prior Authorization for Noninvasive Prenatal Screening (NiPS) 01/02/19 01-19-01 08-19-01 09-19-01 28-19-01 31-19-01 33-19-01 Ch. 1121 Prior Authorization of Anticonvulsants—Pharmacy Services 01/18/19 01-19-06 02-19-05 03-19-05 08-19-08 09-19-06 11-19-05 14-19-05 24-19-05 27-19-06 30-19-05 31-19-06 32-19-05 33-19-06 Ch. 1121 Preferred Drug List (PDL) Update January 28, 2019—
Pharmacy Services01/18/19 01-19-04 02-19-03 03-19-03 08-19-06 09-19-04 11-19-03 14-19-03 24-19-03 27-19-04 30-19-03 31-19-04 32-19-03 33-19-04 Ch. 1121 Prior Authorization of Multiple Sclerosis Agents—Pharmacy Services 01/18/19 01-19-10 02-19-09 03-19-09 08-19-12 09-19-10 11-19-09 14-19-09 24-19-09 27-19-10 30-19-09 31-19-10 32-19-09 33-19-10 Ch. 1121 Prior Authorization of Antiparkinson's Agents—Pharmacy Services 01/18/19 01-19-09 02-19-08 03-19-08 08-19-11 09-19-09 11-19-08 14-19-08 24-19-08 27-19-09 30-19-08 31-19-09 32-19-08 33-19-09 Ch. 1121 Prior Authorization of Pulmonary Arterial Hypertension (PAH) Agents, Oral and Inhaled—Pharmacy Services 01/18/19 01-19-07 02-19-06 03-19-06 08-19-09 09-19-07 11-19-06 14-19-06 24-19-06 27-19-07 30-19-06 31-19-07 32-19-06 33-19-07 Ch. 1121 Prior Authorization of Alpha-1 Proteinase Inhibitors—
Pharmacy Services01/18/19 01-19-08 02-19-07 03-19-07 08-19-10 09-19-08 11-19-07 14-19-07 24-19-07 27-19-08 30-19-07 31-19-08 32-19-07 33-19-08 Ch. 1121 Prior Authorization of Antihyperuricemics—Pharmacy Services 01/18/19 01-19-05 02-19-04 03-19-04 08-19-07 09-19-05 11-19-04 14-19-04 24-19-04 27-19-05 30-19-04 31-19-05 32-19-04 33-19-05 Ch. 1121 Prior Authorization of Radicava (edaravone)—Pharmacy Services 01/21/19 01-19-03 02-19-02 03-19-02 08-19-04 09-19-03 11-19-02 14-19-02 24-19-02 27-19-02 30-19-02 31-19-03 32-19-02 33-19-03 Ch. 1121 Prior Authorization of Symdeko (tezacaftor/ivacaftor)—
Pharmacy Services01/21/19 01-19-02 02-19-01 03-19-01 08-19-03 09-19-02 11-19-01 14-19-01 24-19-01 27-19-01 30-19-01 31-19-02 32-19-01 33-19-02 Ch.1101 1150 Changes to Third-Party Liability Requirements for Claims for Prenatal Services 03/01/19 01-19-12 05-19-01 08-19-14 09-19-12 31-19-12 33-19-12 47-19-01 Ch. 1101 1150 Update to the Administration of the Human Papillomavirus (HPV) Vaccine 04/05/19 01-19-11 08-19-13 09-19-11 31-19-11 33-19-11 Ch. 1241 2019 Recommended Childhood and Adolescent Immunization Schedule 04/22/19 99-19-01 Ch. 1121 Prior Authorization of Dupixent (dupilumab)—Pharmacy Services 6/27/19 01-19-16 02-19-11 03-19-11 08-19-17 09-19-15 11-19-11 14-19-11 24-19-13 27-19-12 30-19-11 31-19-16 32-19-11 33-19-15 Ch. 1121 Prior Authorization of Immunomodulators, Atopic Dermatitis—Pharmacy Services 6/27/19 01-19-17 02-19-12 03-19-12 08-19-18 09-19-16 11-19-12 14-19-12 24-19-14 27-19-13 30-19-12 31-19-17 32-19-12 33-19-16 Ch. 1121 Prior Authorization of Antibiotics, Inhaled—Pharmacy Services 6/27/19 01-19-15 02-19-10 03-19-10 08-19-16 09-19-14 11-19-10 14-19-10 24-19-12 27-19-11 30-19-10 31-19-15 32-19-10 33-19-14 Ch. 1121 Prior Authorization of Complement Inhibitors—Pharmacy Services 6/27/19 01-19-19 02-19-14 03-19-14 08-19-20 09-19-18 11-19-14 14-19-14 24-19-16 27-19-15 30-19-14 31-19-19 32-19-14 33-19-18 Ch. 1121 Prior Authorization of Calcium Channel Blockers—
Pharmacy Services6/27/19 01-19-20 02-19-15 03-19-15 08-19-21 09-19-19 11-19-15 14-19-15 24-19-17 27-19-16 30-19-15 31-19-20 32-19-15 33-19-19 Ch. 1121 Prior Authorization of Xyrem (sodium oxybate)—Pharmacy Services 6/27/19 01-19-18 02-19-13 03-19-13 08-19-19 09-19-17 11-19-13 14-19-13 24-19-15 27-19-14 30-19-13 31-19-18 32-19-13 33-19-17 Ch. 1121 Certified Recovery Specialists in Centers of Excellence 7/17/19 01-19-46 08-19-48 11-19-39 19-19-01 21-19-01 31-19-45 Ch. 1121 Prior Authorization of Antimigraine Agents, Other—
Pharmacy Services7/30/19 01-19-37 02-19-32 03-19-31 08-19-40 09-19-35 11-19-31 14-19-31 24-19-33 27-19-33 30-19-31 31-19-37 32-19-31 33-19-35 Ch. 1121 Prior Authorization of Acne Agents, Oral—Pharmacy Services 7/30/19 01-19-34 02-19-29 03-19-28 08-19-37 09-19-32 11-19-28 14-19-28 24-19-30 27-19-30 30-19-28 31-19-34 32-19-28 33-19-32 Ch. 1121 Prior Authorization of Antimalarials—Pharmacy Services 7/31/19 01-19-38 02-19-33 03-19-32 08-19-41 09-19-36 11-19-32 14-19-32 24-19-34 27-19-34 30-19-32 31-19-38 32-19-32 33-19-36 Ch. 1121 Prior Authorization of Antianginal Agents—Pharmacy Services 7/31/19 01-19-39 02-19-34 03-19-33 08-19-42 09-19-37 11-19-33 14-19-33 24-19-35 27-19-35 30-19-33 31-19-39 32-19-33 33-19-37 Ch. 1121 Prior Authorization of Angiotensin Modulators—Pharmacy Services 7/31/19 01-19-40 02-19-35 03-19-34 08-19-43 09-19-38 11-19-34 14-19-34 24-19-36 27-19-36 30-19-34 31-19-40 32-19-34 33-19-38 Ch. 1121 Prior Authorization of Local Anesthetics, Topical—Pharmacy Services 8/8/19 01-19-25 02-19-20 03-19-19 08-19-28 09-19-23 11-19-19 14-19-19 24-19-21 27-19-21 30-19-19 31-19-25 32-19-19 33-19-23 Ch. 1121 Prior Authorization of Thalidomide and Derivatives—
Pharmacy Services8/8/19 01-19-22 02-19-17 03-19-16 08-19-25 09-19-20 11-19-16 14-19-16 24-19-18 27-19-18 30-19-16 31-19-22 32-19-16 33-19-20 Ch. 1121 Prior Authorization of HIV/AIDS Antiretrovirals—Pharmacy Services 8/8/19 01-19-26 02-19-21 03-19-20 08-19-29 09-19-24 11-19-20 14-19-20 24-19-22 27-19-22 30-19-20 31-19-26 32-19-20 33-19-24 Ch. 1121 Prior Authorization of Colony Stimulating Factors—
Pharmacy Services8/8/19 01-19-27 02-19-22 03-19-21 08-19-30 09-19-25 11-19-21 14-19-21 24-19-23 27-19-23 30-19-21 31-19-27 32-19-21 33-19-25 Ch. 1121 Prior Authorization of Monoclonal Antibodies—Anti-IL, Anti-IgE (MABs—Anti-IL, Anti-IgE)—Pharmacy Services 8/8/19 01-19-24 02-19-19 03-19-18 08-19-27 09-19-22 11-19-18 14-19-18 24-19-20 27-19-20 30-19-18 31-19-24 32-19-18 33-19-22 Ch. 1121 Prior Authorization of Cephalosporins—Pharmacy Services 8/8/19 01-19-28 02-19-23 03-19-22 08-19-31 09-19-26 11-19-22 14-19-22 24-19-24 27-19-24 30-19-22 31-19-28 32-19-22 33-19-26 Ch. 1121 Prior Authorization of Penicillins—Pharmacy Services 8/8/19 01-19-23 02-19-18 03-19-17 08-19-26 09-19-21 11-19-17 14-19-17 24-19-19 27-19-19 30-19-17 31-19-23 32-19-17 33-19-21 Ch. 1101 1150 2019 Healthcare Common Procedure Code System (HCPCS) Updates, Fee Adjustments and Other Procedure Code Changes 8/19/19 99-19-04 Ch. 1241 Pennsylvania's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule 8/19/19 99-19-02 Ch. 1121 Prior Authorization of Bone Density Regulators—Pharmacy Services 8/20/19 01-19-32 02-19-27 03-19-26 08-19-35 09-19-30 11-19-26 14-19-26 24-19-28 27-19-28 30-19-26 31-19-32 32-19-26 33-19-30 Ch. 1121 Prior Authorization of H. Pylori Treatments—Pharmacy Services 8/20/19 01-19-44 02-19-39 03-19-38 08-19-47 09-19-42 11-19-38 14-19-38 24-19-40 27-19-40 30-19-38 31-19-44 32-19-38 33-19-42 Ch. 1121 Prior Authorization of Antivirals, Herpes—Pharmacy Services 8/20/19 01-19-35 02-19-30 03-19-29 08-19-38 09-19-33
11-19-29 14-19-29 24-19-31 27-19-31 30-19-29 31-19-35 32-19-29 33-19-33Ch. 1121 Prior Authorization of Antivirals, Influenza—Pharmacy Services 8/20/19 01-19-33 02-19-28 03-19-27 08-19-36 09-19-31
11-19-27 14-19-27 24-19-29 27-19-29 30-19-27 31-19-33 32-19-27 33-19-31Ch. 1121 Prior Authorization of Antivirals, CMV—Pharmacy Services 8/20/19 01-19-36 02-19-31 03-19-30 08-19-39 09-19-34 11-19-30 14-19-30 24-19-32 27-19-32 30-19-30 31-19-36 32-19-30 33-19-34 Ch. 1121 Prior Authorization of Vaginal Anti-Infectives—Pharmacy Services 8/21/19 01-19-30 02-19-25 03-19-24 08-19-33 09-19-28
11-19-24 14-19-24 24-19-26 27-19-26 30-19-24 31-19-30 32-19-24 33-19-28Ch. 1121 Prior Authorization of Thrombopoietics—Pharmacy Services 8/21/19 01-19-41 02-19-36 03-19-35 08-19-44 09-19-39
11-19-35 14-19-35 24-19-37 27-19-37 30-19-35 31-19-41 32-19-35 33-19-39Ch. 1121 Prior Authorization of Antipsychotics—Pharmacy Services 8/21/19 01-19-43 02-19-38 03-19-37 08-19-46 09-19-41 11-19-37 14-19-37 24-19-39 27-19-39 30-19-37 31-19-43 32-19-37 33-19-41 Ch. 1121 Prior Authorization of COPD Agents—Pharmacy Services 8/21/19 01-19-42 02-19-37 03-19-36 08-19-45 09-19-40 11-19-36 14-19-36 24-19-38 27-19-38 30-19-36 31-19-19 32-19-36 33-19-40 Ch. 1121 Prior Authorization of Vitamin D Analogs—Pharmacy Services 8/21/19 01-19-29 02-19-24 03-19-23 08-19-32 09-19-27 11-19-23 14-19-23 24-19-25 27-19-25 30-19-23 31-19-29 32-19-23 33-19-27 Ch. 1121 Prior Authorization of Urinary Anti-Infectives—Pharmacy Services 8/21/19 01-19-31 02-19-26 03-19-25 08-19-34 09-19-29 11-19-25 14-19-25 24-19-27 27-19-27 30-19-25 31-19-31 32-19-25 33-19-29 Ch. 1101 Corrected—Diabetes Prevention Program Enrollment in the Medical Assistance Program 8/22/19 99-19-06 Ch. 1225 Family Planning Services Program 8/23/19 01-19-13 08-19-15 09-19-13 24-19-10 25-19-01 28-19-02 31-19-13 33-19-13 Ch. 1121 Prior Authorization of Antihyperuricemics—Pharmacy Services 9/3/19 01-19-50 02-19-44 03-19-43 08-19-52 09-19-46 11-19-43 14-19-42 24-19-44 27-19-44 30-19-42 31-19-49 32-19-42 33-19-46 Ch. 1121 Prior Authorization of Intranasal Rhinitis Agents—Pharmacy Services 9/3/19 01-19-62 02-19-56 03-19-55 08-19-64 09-19-58 11-19-55 14-19-54 24-19-56 27-19-56 30-19-54 31-19-61 32-19-54 33-19-58 Ch. 1121 Prior Authorization of Antihistamines, Minimally Sedating—Pharmacy Services 9/3/19 01-19-51 02-19-45 03-19-44 08-19-53 09-19-47 11-19-44 14-19-43 24-19-45 27-19-45 30-19-43 31-19-50 32-19-43 33-19-47 Ch. 1121 Prior Authorization of Antihemophilia Agents—Pharmacy Services 9/3/19 01-19-52 02-19-46 03-19-45 08-19-54 09-19-48 11-19-45 14-19-44 24-19-46 27-19-46 30-19-44 31-19-51 32-19-44 33-19-48 (Editor's Note: This document continues with the Governor's Office's Catalog of Nonregulatory Documents in Part V at 54 Pa.B. 4941 (August 3, 2024).)
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