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PA Bulletin, Doc. No. 24-597



Medical Assistance Program Fee Schedule Revisions; Prior Authorization Requirements; Unit and Service Limitation Updates

[54 Pa.B. 2330]
[Saturday, April 27, 2024]

 The Department of Human Services (Department) announces changes to the Medical Assistance (MA) Program Fee Schedule. These changes are effective for dates of service on and after April 29, 2024, unless otherwise noted.

 The Department is adding procedure codes based upon provider requests and clinical review. The Department is also removing the prior authorization requirement from one procedure code based upon clinical review. In addition, the Department is updating unit and service limitations for numerous procedure codes based upon National Correct Coding Initiative edits and clinical review.

Procedure Codes Being Added

 The Department is adding the following procedure codes to the MA Program Fee Schedule based upon provider requests and clinical review:

Procedure Codes


Prior Authorization Requirements

 The Department is removing the prior authorization requirement from procedure code 81511 as authorized by section 443.6(b)(7) of the Human Services Code (62 P.S. § 443.6(b)(7)), based upon clinical review.

Fiscal Impact

 There is minimal fiscal impact associated with the revisions and updates to the procedure codes.

Public Comment

 Interested persons are invited to submit written comments to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120 or to Comments received within 30 days will be reviewed and considered for any subsequent revisions to the MA Program Fee Schedule.

 Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


Fiscal Note: 14-NOT-1618. No fiscal impact; recommends adoption.

[Pa.B. Doc. No. 24-597. Filed for public inspection April 26, 2024, 9:00 a.m.]

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