Pennsylvania Medicaid DME Fee Schedule Rates 2026

Pennsylvania Medicaid DME billing is not as simple as finding an HCPCS code and copying the reimbursement amount into your billing system.

For a Fee-for-Service claim, payment can depend on the exact HCPCS code, provider type, specialty, place of service, applicable modifiers, units, effective date, prior authorization status, and the supplier’s enrollment information.

That is why DME suppliers should use the Pennsylvania Medicaid fee schedule as a billing decision tool, not just a price list.

For the most current Fee-for-Service information, Pennsylvania Department of Human Services Medicaid Fee Schedules directs providers to its online Medical Assistance fee schedule. The downloadable PROMISe schedule is updated quarterly, while the online database is refreshed daily.

If you are preparing a high-value DME claim, rental, replacement, authorization-sensitive item, or service affected by a recent policy change, checking the current state record before billing can prevent an expensive correction later. If your team needs help managing that process across payers, our DME billing service supports eligibility, coding, documentation, claim submission, denials, and reimbursement follow-up.

Pennsylvania Medicaid DME Fee Schedule 2026

Pennsylvania Medical Assistance 2026 HCPCS update

Every code change in Bulletin 99-26-04: new procedure codes and fees, fee increases, prior authorization changes and the codes being end-dated. Search by code or description.

Search codes and descriptions

Attachment effective: August 1, 2026
Bulletin: 99-26-04
Codes with new fees: 107

This is the 2026 HCPCS update bulletin, not the full Pennsylvania DME fee schedule. It lists only the codes that changed on August 1, 2026. The priced codes here are surgical, radiology, laboratory and monitoring procedures. DME impact is limited to four end-dated prosthetic codes, shown under the DME impact tab. For standing DME rates, use the PA MA Program Fee Schedule instead.

Priced codes107 codes, 438 fee rows

Each code is listed once. Open it to see every provider type, place of service and modifier combination, since the MA fee changes with each.

27458Osteotomy(ies), femur, unilateral, with insertion of an externally controlled intramedullary lengthening device, including iliotibial band release when performed, imaging, alignment assessments, computations of adjustment schedules, and management of the intramedullary lengthening device$213.39–$1,333.71New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 90 days
Prior authorization: AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
31	All	21	RT-LT-50	$1,333.71
31	All	21	80 RT-LT-50	$213.39

2 fee rows in the bulletin attachment, PDF page 7.

27713Osteotomy(ies), tibia, including fibula when performed, unilateral, with insertion of an externally controlled intramedullary lengthening device, including imaging, alignment assessments, computations of adjustment schedules, and management of the intramedullary lengthening device$216.50–$1,353.15New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 90 days
Prior authorization: AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
31	All	21	RT-LT-50	$1,353.15
31	All	21	80 RT-LT-50	$216.50
31	All	24	RT-LT-50	$1,353.15
31	All	24	80 RT-LT-50	$216.50

6 fee rows in the bulletin attachment, PDF page 7.

33882Endovascular repair of the thoracic aorta by deployment of a branched endograft multipiece system involving an aorto-aortic tube device with a fenestration for the left subclavian artery stent graft(s) and all aortic tube endograft extension(s) placed from the level of the left common carotid artery to the celiac artery, including pre-procedure sizing and device selection, all target zone angioplasty, all nonselective catheterization(s) and left subclavian artery selective catheterization(s), and all associated radiological supervision and interpretation$220.35–$1,377.18New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 90 days
Prior authorization: AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
31	All	21	—	$1,377.18
31	All	21	80	$220.35

2 fee rows in the bulletin attachment, PDF page 8.

35602Bypass graft, with other than vein; carotid-contralateral carotid$144.77–$904.82New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 90 days
Prior authorization: AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
31	All	21	RT-LT-50	$904.82
31	All	21	80 RT-LT-50	$144.77

2 fee rows in the bulletin attachment, PDF page 8.

37254Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, initial vessel$263.75–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$263.75
31	All	21, 24, 99	RT-LT-50	$263.75

4 fee rows in the bulletin attachment, PDF page 9.

37255Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure)$106.92New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$106.92
31	All	21, 24, 99	RT-LT-50	$106.92

2 fee rows in the bulletin attachment, PDF page 9.

37256Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, initial vessel$386.69–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$386.69
31	All	21, 24, 99	RT-LT-50	$386.69

4 fee rows in the bulletin attachment, PDF page 10.

37257Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure)$138.46New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$138.46
31	All	21, 24, 99	RT-LT-50	$138.46

2 fee rows in the bulletin attachment, PDF page 11.

37258Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; straightforward lesion, initial vessel$315.28–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$315.28
31	All	21, 24, 99	RT-LT-50	$315.28

4 fee rows in the bulletin attachment, PDF page 11.

37259Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure)$142.66New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$142.66
31	All	21, 24, 99	RT-LT-50	$142.66

2 fee rows in the bulletin attachment, PDF page 12.

37260Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; complex lesion, initial vessel$455.82–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$455.82
31	All	21, 24, 99	RT-LT-50	$455.82

4 fee rows in the bulletin attachment, PDF page 13.

37261Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure)$151.60New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$151.60
31	All	21, 24, 99	RT-LT-50	$151.60

2 fee rows in the bulletin attachment, PDF page 14.

37263Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, initial vessel$279.78–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$279.78
31	All	21, 24, 99	RT-LT-50	$279.78

4 fee rows in the bulletin attachment, PDF page 14.

37264Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure)$107.16New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$107.16
31	All	21, 24, 99	RT-LT-50	$107.16

2 fee rows in the bulletin attachment, PDF page 15.

37265Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, initial vessel$378.51–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$378.51
31	All	21, 24, 99	RT-LT-50	$378.51

4 fee rows in the bulletin attachment, PDF page 15.

37266Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure)$142.63New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$142.63
31	All	21, 24, 99	RT-LT-50	$142.63

2 fee rows in the bulletin attachment, PDF page 16.

37267Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; straightforward lesion, initial vessel$315.53–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$315.53
31	All	21, 24, 99	RT-LT-50	$315.53

4 fee rows in the bulletin attachment, PDF page 16.

37268Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure)$133.42New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$133.42
31	All	21, 24, 99	RT-LT-50	$133.42

2 fee rows in the bulletin attachment, PDF page 17.

37269Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; complex lesion, initial vessel$530.36–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$530.36
31	All	21, 24, 99	RT-LT-50	$530.36

4 fee rows in the bulletin attachment, PDF page 18.

37270Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure)$179.11New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$179.11
31	All	21, 24, 99	RT-LT-50	$179.11

2 fee rows in the bulletin attachment, PDF page 19.

37271Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; straightforward lesion, initial vessel$323.37–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$323.37
31	All	21, 24, 99	RT-LT-50	$323.71

4 fee rows in the bulletin attachment, PDF page 19.

37272Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure)$142.60New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$142.60
31	All	21, 24, 99	RT-LT-50	$142.60

2 fee rows in the bulletin attachment, PDF page 20.

37273Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; complex lesion, initial vessel$452.84–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$452.84
31	All	21, 24, 99	RT-LT-50	$452.84

4 fee rows in the bulletin attachment, PDF page 21.

37274Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure)$196.42New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$196.42
31	All	21, 24, 99	RT-LT-50	$196.42

2 fee rows in the bulletin attachment, PDF page 22.

37275Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; straightforward lesion, initial vessel$394.10–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$394.10
31	All	21, 24, 99	RT-LT-50	$394.10

4 fee rows in the bulletin attachment, PDF page 22.

37276Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure)$151.55New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$151.55
31	All	21, 24, 99	RT-LT-50	$151.55

2 fee rows in the bulletin attachment, PDF page 23.

37277Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; complex lesion, initial vessel$535.98–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$535.98
31	All	21, 24, 99	RT-LT-50	$535.98

4 fee rows in the bulletin attachment, PDF page 24.

37278Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure)$213.06New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$213.06
31	All	21, 24, 99	RT-LT-50	$213.06

2 fee rows in the bulletin attachment, PDF page 25.

37280Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, initial vessel$351.84–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$351.84
31	All	21, 24, 99	RT-LT-50	$351.84

4 fee rows in the bulletin attachment, PDF page 25.

37281Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure)$105.90New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$105.90
31	All	21, 24, 99	RT-LT-50	$105.90

2 fee rows in the bulletin attachment, PDF page 26.

37282Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, initial vessel$441.41–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$441.41
31	All	21, 24, 99	RT-LT-50	$441.41

4 fee rows in the bulletin attachment, PDF page 27.

37283Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, complex lesion, each additional vessel (List separately in addition to code for primary procedure)$150.82New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$150.82
31	All	21, 24, 99	RT-LT-50	$150.82

2 fee rows in the bulletin attachment, PDF page 27.

37284Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; straightforward lesion, initial vessel$362.57–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$362.57
31	All	21, 24, 99	RT-LT-50	$362.57

4 fee rows in the bulletin attachment, PDF page 28.

37285Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure)$119.70New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$119.70
31	All	21, 24, 99	RT-LT-50	$119.70

2 fee rows in the bulletin attachment, PDF page 29.

37286Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; complex lesion, initial vessel$486.24–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$486.24
31	All	21, 24, 99	RT-LT-50	$486.24

4 fee rows in the bulletin attachment, PDF page 29.

37287Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure)$180.04New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$180.04
31	All	21, 24, 99	RT-LT-50	$180.04

2 fee rows in the bulletin attachment, PDF page 30.

37288Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; straightforward lesion, initial vessel$479.30–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$479.30
31	All	21, 24, 99	RT-LT-50	$479.30

4 fee rows in the bulletin attachment, PDF page 31.

37289Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure)$168.86New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$168.86
31	All	21, 24, 99	RT-LT-50	$168.86

2 fee rows in the bulletin attachment, PDF page 32.

37290Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; complex lesion, initial vessel$603.03–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$603.03
31	All	21, 24, 99	RT-LT-50	$603.03

4 fee rows in the bulletin attachment, PDF page 32.

37291Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure)$230.34New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$230.34
31	All	21, 24, 99	RT-LT-50	$230.34

2 fee rows in the bulletin attachment, PDF page 33.

37292Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; straightforward lesion, initial vessel$533.74–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$533.74
31	All	21, 24, 99	RT-LT-50	$533.74

4 fee rows in the bulletin attachment, PDF page 34.

37293Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure)$234.50New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$234.50
31	All	21, 24, 99	RT-LT-50	$234.50

2 fee rows in the bulletin attachment, PDF page 35.

37294Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; complex lesion, initial vessel$639.86–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$639.86
31	All	21, 24, 99	RT-LT-50	$639.86

4 fee rows in the bulletin attachment, PDF page 36.

37295Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure)$295.57New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$295.57
31	All	21, 24, 99	RT-LT-50	$295.57

2 fee rows in the bulletin attachment, PDF page 37.

37296Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, initial vessel$394.14–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$394.14
31	All	21, 24, 99	RT-LT-50	$394.14

4 fee rows in the bulletin attachment, PDF page 37.

37297Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure)$141.37New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$141.37
31	All	21, 24, 99	RT-LT-50	$141.37

2 fee rows in the bulletin attachment, PDF page 38.

37298Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, initial vessel$486.50–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	RT-LT-50	$486.50
31	All	21, 24, 99	RT-LT-50	$486.50

4 fee rows in the bulletin attachment, PDF page 38.

37299Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure)$176.07New for 2026AUR / PSR

Units: per procedure
Limits: Once per R side and once per L side, per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	RT-LT-50	$176.07
31	All	21, 24, 99	RT-LT-50	$176.07

2 fee rows in the bulletin attachment, PDF page 39.

43889Gastric restrictive procedure, transoral, endoscopic sleeve gastroplasty (ESG), including argon plasma coagulation, when performed$557.57–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 90 days
Prior authorization: AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
31	All	21, 24	—	$557.57

3 fee rows in the bulletin attachment, PDF page 39.

52597Transurethral robotic-assisted waterjet resection of prostate, including intraoperative planning, ultrasound guidance, control of postoperative bleeding, complete, including vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy, when performed$426.18–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 90 days
Prior authorization: AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
31	All	21, 24	—	$426.18

3 fee rows in the bulletin attachment, PDF page 40.

55707Biopsy, prostate, transrectal, ultrasound-guided (ie, sextant, ultrasound-localized discrete lesion[s])$106.10–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	—	$106.10
31	All	21, 24	—	$106.10

4 fee rows in the bulletin attachment, PDF page 40.

55708Biopsy, prostate, transrectal, ultrasound-guided (ie, sextant) with MRI-fusion-guidance, first targeted lesion$132.35–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	—	$132.35
31	All	21, 24	—	$132.35

4 fee rows in the bulletin attachment, PDF page 40.

55709Biopsy, prostate, transperineal, ultrasound-guided (ie, sextant, ultrasound-localized discrete lesion[s])$127.09–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	—	$127.09
31	All	21, 24	—	$127.09

4 fee rows in the bulletin attachment, PDF page 41.

55710Biopsy, prostate, transperineal, ultrasound-guided (ie, sextant) with MRI-fusion-guidance biopsy, first targeted lesion$147.04–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	—	$147.04
31	All	21, 24	—	$147.04

4 fee rows in the bulletin attachment, PDF page 41.

55711Biopsy, prostate, transrectal, MRI-ultrasound-fusion guided, targeted lesion(s) only, first targeted lesion$105.56–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	—	$105.56
31	All	21, 24	—	$105.56

4 fee rows in the bulletin attachment, PDF page 41.

55712Biopsy, prostate, transperineal, MRI-ultrasound-fusion guided, targeted lesion(s) only, first targeted lesion$123.11–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	—	$123.11
31	All	21, 24	—	$123.11

4 fee rows in the bulletin attachment, PDF page 42.

55713Biopsy, prostate, in-bore CT- or MRI-guided (ie, sextant), with biopsy of additional targeted lesion(s), first targeted lesion$145.51–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	—	$145.51
31	All	21, 24	—	$145.51

4 fee rows in the bulletin attachment, PDF page 42.

55714Biopsy, prostate, in-bore CT- or MRI-guided targeted lesion(s) only, first targeted lesion$132.38–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	—	$132.38
31	All	21, 24	—	$132.38

4 fee rows in the bulletin attachment, PDF page 42.

55715Biopsy, prostate, each additional, MRI-ultrasound fusion or in-bore CT- or MRI-guided targeted lesion (List separately in addition to code for primary procedure)$36.99New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$36.99
31	All	21, 24	—	$36.99

2 fee rows in the bulletin attachment, PDF page 43.

55868Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed; with lymph node biopsy(ies) (limited pelvic lymphadenectomy)$138.35–$864.71New for 2026AUR / PSR

Units: per procedure
Limits: once per lifetime
Post-op days: 90 days
Prior authorization: AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
31	All	21	—	$864.71
31	All	21	80	$138.35

2 fee rows in the bulletin attachment, PDF page 43.

55869Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes$166.15–$1,038.41New for 2026AUR / PSR

Units: per procedure
Limits: once per lifetime
Post-op days: 90 days
Prior authorization: AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
31	All	21	—	$1,038.41
31	All	21	80	$166.15

2 fee rows in the bulletin attachment, PDF page 43.

70471Computed tomographic angiography (CTA), head and neck, with contrast material(s), including noncontrast images, when performed, and image postprocessing$92.42–$282.30New for 2026Prior auth

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: Required
PA combinations: 70471, 70471 (TC), 70471 (26)

Provider type	Specialty	Place of service	Modifiers	MA fee
01	016, 017	23	—	$282.30
01	016, 017	23	TC	$189.88
01	183	22	—	$282.30
01	183	22	TC	$189.88
08	082	49	—	$282.30
08	082	49	TC	$189.88
31	All	11	—	$282.30
31	All	11	TC	$189.88
31	All	11, 21, 22, 23, 49	26	$92.42

9 fee rows in the bulletin attachment, PDF page 43.

70472Computed tomographic (CT) cerebral perfusion analysis with contrast material(s), including image postprocessing performed with concurrent CT or CT angiography of the same anatomy (List separately in addition to code for primary procedure)$28.46–$116.53New for 2026Prior auth

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: Required
PA combinations: 70472, 70472 (TC), 70472 (26)

Provider type	Specialty	Place of service	Modifiers	MA fee
01	016, 017	23	—	$116.53
01	016, 017	23	TC	$88.07
01	183	22	—	$116.53
01	183	22	TC	$88.07
08	082	49	—	$116.53
08	082	49	TC	$88.07
31	All	11	—	$116.53
31	All	11	TC	$88.07
31	All	11, 21, 22, 23, 49	26	$28.46

9 fee rows in the bulletin attachment, PDF page 44.

70473Computed tomographic (CT) cerebral perfusion analysis with contrast material(s), including image postprocessing performed without concurrent CT or CT angiography of the same anatomy$37.06–$179.36New for 2026Prior auth

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: Required
PA combinations: 70473, 70473 (TC), 70473 (26)

Provider type	Specialty	Place of service	Modifiers	MA fee
01	016, 017	23	—	$179.36
01	016, 017	23	TC	$142.30
01	183	22	—	$179.36
01	183	22	TC	$142.30
08	082	49	—	$179.36
08	082	49	TC	$142.30
31	All	11	—	$179.36
31	All	11	TC	$142.30
31	All	11, 21, 22, 23, 49	26	$37.06

9 fee rows in the bulletin attachment, PDF page 45.

75577Quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, derived from augmentative software analysis of the data set from a coronary computed tomographic angiography, with interpretation and report by a physician or other qualified health care professional$32.31–$745.14New for 2026Prior auth

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: Required
PA combinations: 75577, 75577 (TC), 75577 (26)

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$745.14
01	183	22	TC	$712.83
08	082	49	—	$745.14
08	082	49	TC	$712.83
31	All	11	—	$745.14
31	All	11	TC	$712.83
31	All	11, 21, 22, 49	26	$32.31

7 fee rows in the bulletin attachment, PDF page 46.

77436Surface radiation therapy; superficial or orthovoltage, treatment planning and simulation-aided field setting$26.99–$59.36New for 2026

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$59.36
01	183	22	TC	$26.99
31	All	11	—	$59.36
31	All	11	TC	$26.99
31	All	11, 21, 22	26	$32.37

5 fee rows in the bulletin attachment, PDF page 47.

77437Surface radiation therapy; superficial, delivery, =150 kV, per fraction (eg, electronic brachytherapy)$80.46New for 2026

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$80.46
31	All	11	—	$80.46

2 fee rows in the bulletin attachment, PDF page 47.

77438Surface radiation therapy; orthovoltage, delivery, >150-500 kV, per fraction$81.20New for 2026

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$81.20
31	All	11	—	$81.20

2 fee rows in the bulletin attachment, PDF page 47.

77439Surface radiation therapy; superficial or orthovoltage, image guidance, ultrasound for placement of radiation therapy fields for treatment of cutaneous tumors, per course of treatment (List separately in addition to code for primary procedure)$12.43New for 2026

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
31	All	11, 22	26	$12.43

1 fee row in the bulletin attachment, PDF page 47.

87494Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis and Neisseria gonorrhoeae, multiplex amplified probe technique$56.14New for 2026

Units: per test
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	016, 017	23	—	$56.14
01	016, 017	23	QW	$56.14
01	183	22	—	$56.14
01	183	22	QW	$56.14
01	183	22	FP	$56.14
01	183	22	QW, FP	$56.14
08	082	49	—	$56.14
08	082	49	QW	$56.14
08	082	49	FP	$56.14
08	082	49	QW, FP	$56.14
08	083	22, 49	FP	$56.14
08	083	22, 49	QW, FP	$56.14
09	All	11, 27	—	$56.14
09	All	11, 27	QW	$56.14
09	All	11, 27	FP	$56.14
09	All	11, 27	QW, FP	$56.14
10	100	11, 27	—	$56.14
10	100	11, 27	QW	$56.14
10	100	11, 27	FP	$56.14
10	100	11, 27	QW, FP	$56.14
28	280	81	—	$56.14
28	280	81	QW	$56.14
28	280	81	FP	$56.14
28	280	81	QW, FP	$56.14
31	All	11, 27	—	$56.14
31	All	11, 27	QW	$56.14
31	All	11, 27	FP	$56.14
31	All	11, 27	QW, FP	$56.14
33	335	11, 27	—	$56.14
33	335	11, 27	QW	$56.14
33	335	11, 27	FP	$56.14
33	335	11, 27	QW, FP	$56.14

32 fee rows in the bulletin attachment, PDF page 47.

87812Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) and influenza virus types A and B$59.58New for 2026

Units: per test
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	016, 017	23	—	$59.58
01	016, 017	23	QW	$59.58
01	183	22	—	$59.58
01	183	22	QW	$59.58
08	082	49	—	$59.58
08	082	49	QW	$59.58
09	All	11, 27	—	$59.58
09	All	11, 27	QW	$59.58
10	100	11, 27	—	$59.58
10	100	11, 27	QW	$59.58
10	247	11	—	$59.58
10	247	11	QW	$59.58
28	280	81	—	$59.58
28	280	81	QW	$59.58
31	All	11, 27	—	$59.58
31	All	11 27	QW	$59.58
33	335	11, 27	—	$59.58
33	335	11, 27	QW	$59.58

18 fee rows in the bulletin attachment, PDF page 50.

90482Immunization counseling by physician or other qualified health care professional when immunization(s) is not administered by provider on the same date of service; 3 minutes up to 10 minutes$8.39New for 2026

Units: per visit
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	02, 10, 22	—	$8.39
08	082	02, 10, 49	—	$8.39
09	ALL	02, 10, 11, 12	—	$8.39
10	100	02, 10, 11, 12	—	$8.39
10	247	02, 10, 11	—	$8.39
31	ALL	02, 10, 11, 12	—	$8.39
33	335	02, 10, 11, 12	—	$8.39

7 fee rows in the bulletin attachment, PDF page 51.

91124Rectal sensation, tone, and compliance study (eg, barostat)$127.01–$571.27New for 2026

Units: per test
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$571.27
01	183	22	TC	$444.26
08	082	49	—	$571.27
08	082	49	TC	$444.26
31	All	11	—	$571.27
31	All	11	TC	$444.26
31	All	11, 21, 22, 49	26	$127.01

7 fee rows in the bulletin attachment, PDF page 52.

91125Anorectal manometry, with rectal sensation and rectal balloon expulsion test, when performed$110.52–$261.14New for 2026

Units: per test
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$261.14
01	183	22	TC	$150.62
08	082	49	—	$261.14
08	082	49	TC	$150.62
31	All	11	—	$261.14
31	All	11	TC	$150.62
31	All	11, 21, 22, 49	26	$110.52

7 fee rows in the bulletin attachment, PDF page 52.

92288Screening dark adaptation measurement (eg, rod recovery intercept time), with interpretation and report$17.79New for 2026

Units: per test
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$17.79
08	082	49	—	$17.79
18	180	11, 21	—	$17.79
31	All	11, 21	—	$17.79

4 fee rows in the bulletin attachment, PDF page 52.

92628Evaluation for hearing aid candidacy, unilateral or bilateral, including review and integration of audiologic function tests, assessment, and interpretation of hearing needs (eg, speech-in- noise, suprathreshold hearing measures), discussion of candidacy results, counseling on treatment options with report, and, when performed, assessment of cognitive and communication status; first 30 minutes$18.00New for 2026

Units: first 30 minutes
Limits: once per 180 days
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$18.00
08	082	49	—	$18.00
20	All	11	—	$18.00
31	All	11, 12, 21, 31, 32	—	$18.00

4 fee rows in the bulletin attachment, PDF page 53.

92629Evaluation for hearing aid candidacy, unilateral or bilateral, including review and integration of audiologic function tests, assessment, and interpretation of hearing needs (eg, speech-in- noise, suprathreshold hearing measures), discussion of candidacy results, counseling on treatment options with report, and, when performed, assessment of cognitive and communication status; each additional 15 minutes (List separately in addition to code for primary procedure)$18.00New for 2026

Units: per 15 minutes
Limits: twice per 180 days
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$18.00
08	082	49	—	$18.00
20	All	11	—	$18.00
31	All	11, 12, 21, 31, 32	—	$18.00

4 fee rows in the bulletin attachment, PDF page 53.

92631Hearing aid selection services, unilateral or bilateral, including review of audiologic function tests and hearing aid candidacy evaluation, assessment of visual and dexterity limitations, and psychosocial factors, establishment of device type, output requirements, signal processing strategies and additional features, discussion of device recommendations with report; first 30 minutes$18.00New for 2026

Units: first 30 minutes
Limits: once per 180 days
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$18.00
08	082	49	—	$18.00
20	All	11	—	$18.00
31	All	11, 12, 21, 31, 32	—	$18.00

4 fee rows in the bulletin attachment, PDF page 54.

92632Hearing aid selection services, unilateral or bilateral, including review of audiologic function tests and hearing aid candidacy evaluation, assessment of visual and dexterity limitations, and psychosocial factors, establishment of device type, output requirements, signal processing strategies and additional features, discussion of device recommendations with report; each additional 15 minutes (List separately in addition to code for primary procedure)$18.00New for 2026

Units: per 15 minutes
Limits: twice per 180 days
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$18.00
08	082	49	—	$18.00
20	All	11	—	$18.00
31	All	11, 12, 21, 31, 32	—	$18.00

4 fee rows in the bulletin attachment, PDF page 55.

92636Hearing aid post-fitting follow-up services, unilateral or bilateral, including confirmation of physical fit, validation of patient benefit and performance, sound quality of device, adjustment(s) (eg, verification, programming adjustment[s], device connection[s], and device training), as indicated, and, when performed, hearing assistive device, supplemental technology fitting services; first 30 minutes$12.00New for 2026

Units: first 30 minutes; per visit
Limits: once per day; 4 per calendar month
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$12.00
08	082	49	—	$12.00
20	All	11	—	$12.00
31	All	11, 12, 21 31, 32	—	$12.00
35	350	11	U3 TM	$12.00

5 fee rows in the bulletin attachment, PDF page 56.

92637Hearing aid post-fitting follow-up services, unilateral or bilateral, including confirmation of physical fit, validation of patient benefit and performance, sound quality of device, adjustment(s) (eg, verification, programming adjustment[s], device connection[s], and device training), as indicated, and, when performed, hearing assistive device, supplemental technology fitting services; each additional 15 minutes (List separately in addition to code for primary procedure)$9.00New for 2026

Units: per 15 minutes
Limits: twice per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$9.00
08	082	49	—	$9.00
20	All	11	—	$9.00
31	All	11, 12, 21 31, 32	—	$9.00

4 fee rows in the bulletin attachment, PDF page 57.

92639Hearing-aid measurement, verification with probe-microphone (List separately in addition to code for primary procedure)$12.00New for 2026

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$12.00
08	082	49	—	$12.00
20	All	11	—	$12.00
31	All	11, 12, 21 31, 32	—	$12.00

4 fee rows in the bulletin attachment, PDF page 57.

92641Hearing device verification, electroacoustic analysis$9.00New for 2026

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$9.00
08	082	49	—	$9.00
20	All	11	—	$9.00
31	All	11, 12, 21 31, 32	—	$9.00

4 fee rows in the bulletin attachment, PDF page 57.

92930Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed, single major coronary artery and/or its branch(es); 2 or more distinct coronary lesions with 2 or more coronary stents deployed in 2 or more coronary segments, or a bifurcation lesion requiring angioplasty and/or stenting in both the main artery and the side branch$398.05–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	—	$398.05
31	All	21, 24	—	$398.05

4 fee rows in the bulletin attachment, PDF page 58.

92945Percutaneous transluminal revascularization of chronic total occlusion, single coronary artery, coronary artery branch, or coronary artery bypass graft, and/or subtended major coronary artery branches of the bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; combined antegrade and retrograde approaches$497.74–$776.00New for 2026AUR / PSR

Units: per procedure
Limits: once per day
Post-op days: 0 days
Prior authorization: No; AUR / PSR

Provider type	Specialty	Place of service	Modifiers	MA fee
01	021	24	SG	$776.00
02	020	24	SG	$776.00
01	183	22	—	$497.74
31	All	21, 24	—	$497.74

4 fee rows in the bulletin attachment, PDF page 58.

98979Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least 1 real-time interactive communication with the patient or caregiver during the calendar month; first 10 minutes$9.02New for 2026

Units: first 10 minutes
Limits: once per calendar month
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$9.02
08	082	49	—	$9.02
09	All	11, 12	—	$9.02
10	100	11, 12	—	$9.02
10	247	11, 12	—	$9.02
31	All	11, 12	—	$9.02
33	335	11, 12	—	$9.02

7 fee rows in the bulletin attachment, PDF page 59.

98984Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of respiratory system, 2-15 days in a 30-day period$38.27New for 2026

Units: per procedure, minimum of 2 days
Limits: once per calendar month
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$38.27
08	082	49	—	$38.27
09	All	11, 12	—	$38.27
10	100	11, 12	—	$38.27
10	247	11, 12	—	$38.27
31	All	11, 12	—	$38.27
33	335	11, 12	—	$38.27

7 fee rows in the bulletin attachment, PDF page 60.

98985Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of musculoskeletal system, 2-15 days in a 30-day period$37.78New for 2026

Units: per procedure, minimum of 2 days
Limits: once per calendar month
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$37.78
08	082	49	—	$37.78
09	All	11, 12	—	$37.78
10	100	11, 12	—	$37.78
10	247	11, 12	—	$37.78
31	All	11, 12	—	$37.78
33	335	11, 12	—	$37.78

7 fee rows in the bulletin attachment, PDF page 60.

99445Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate); device(s) supply with daily recording(s) or programmed alert(s) transmission, 2- 15 days in a 30-day period$38.27New for 2026

Units: per procedure, minimum of 2 days
Limits: once per calendar month
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$38.27
08	082	49	—	$38.27
09	All	11, 12	—	$38.27
10	100	11, 12	—	$38.27
10	247	11, 12	—	$38.27
31	All	11, 12	—	$38.27
33	335	11, 12	—	$38.27

7 fee rows in the bulletin attachment, PDF page 61.

99470Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring 1 real-time interactive communication with the patient/caregiver during the calendar month; first 10 minutes$10.50New for 2026

Units: first ten minutes
Limits: once per calendar month
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$10.50
08	082	49	—	$10.50
09	All	11, 12	—	$10.50
10	100	11, 12	—	$10.50
10	247	11, 12	—	$10.50
31	All	11, 12	—	$10.50
33	335	11, 12	—	$10.50

7 fee rows in the bulletin attachment, PDF page 62.

D9224Administration of general anesthesia with advanced airway – first 15 minute increment, or any portion thereof; With or without co-administration of nitrous oxide. Anesthesia time begins when the doctor administering the anesthetic agent initiates the appropriate anesthesia and non-invasive monitoring protocol and remains in continuous attendance of the patient. Anesthesia services are considered completed when the patient may be safely left under the observation of trained personnel and the doctor may safely leave the room. This procedure is determined by the provider's documentation of the presence of an advanced airway such as a supraglottic or subglottic airway device, which includes laryngeal tube, esophageal-tracheal tube (Combitube), laryngeal mask airway, or endotracheal tube.$156.00New for 2026

Units: first 15 minutes
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
27	284	11	—	$156.00

1 fee row in the bulletin attachment, PDF page 63.

D9225Administration of general anesthesia with advanced airway – each subsequent 15 minute increment, or any portion thereof$156.00New for 2026

Units: per 15 minutes
Limits: twice per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
27	284	11	—	$156.00

1 fee row in the bulletin attachment, PDF page 63.

D9244In-office administration of minimal sedation – single drug-enteral; In- office administration of a drug, as a single or divided dose, to achieve the desired clinical effect, not to exceed the FDA maximum recommended dose (MRD) for unmonitored home use. The single drug may be administered with or without co-administration of nitrous oxide.$111.00New for 2026

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
27	284, 285, 286	11	—	$111.00

1 fee row in the bulletin attachment, PDF page 63.

D9245Administration of moderate sedation – enteral; When moderate sedation is achieved by administration of drug(s) by enteral route only. With or without co-administration of nitrous oxide. The level of anesthesia is determined by the provider's documentation of the anesthetic effects upon the central nervous system.$111.00New for 2026

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
27	284, 285	11	—	$111.00

1 fee row in the bulletin attachment, PDF page 63.

D9246Administration of moderate sedation – non-intravenous parenteral – first 15 minute increment, or any portion thereof; When moderate sedation is achieved by administration of drug(s) by parenteral route, not including intravenous. With or without co-administration of nitrous oxide. Anesthesia time begins when the doctor administering the anesthetic agent initiates the appropriate anesthesia and non-invasive monitoring protocol and remains in continuous attendance of the patient. Anesthesia services are considered completed when the patient may be safely left under the observation of trained personnel and the doctor may safely leave the room. The level of anesthesia is determined by the provider's documentation of the anesthetic effects upon the central nervous system.$123.00New for 2026

Units: first 15 minutes
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
27	284, 285	11	—	$123.00

1 fee row in the bulletin attachment, PDF page 64.

D9247Administration of moderate sedation – non-intravenous parenteral – each subsequent 15 minute increment, or any portion thereof$101.00New for 2026

Units: per 15 minutes
Limits: twice per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
27	284, 285	11	—	$101.00

1 fee row in the bulletin attachment, PDF page 64.

98975Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); initial set-up and patient education on use of equipment$15.96Clinical review

Units: per procedure; per visit
Limits: once per 90 days
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$15.96
08	082	49	—	$15.96
09	All	11, 12	—	$15.96
10	100, 247	11, 12	—	$15.96
31	All	11, 12	—	$15.96
33	335	11, 12	—	$15.96

6 fee rows in the bulletin attachment, PDF page 64.

98976Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of respiratory system, 16-30 days in a 30-day period$38.27Clinical review

Units: per procedure, minimum of 16 days
Limits: once per calendar month
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$38.27
08	082	49	—	$38.27
09	All	11, 12	—	$38.27
10	100, 247	11, 12	—	$38.27
31	All	11, 12	—	$38.27
33	335	11, 12	—	$38.27

6 fee rows in the bulletin attachment, PDF page 64.

98977Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of musculoskeletal system, 16-30 days in a 30-day period$37.78Clinical review

Units: per procedure, minimum of 16 days
Limits: once per calendar month
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$37.78
08	082	49	—	$37.78
09	All	11, 12	—	$37.78
10	100, 247	11, 12	—	$37.78
31	All	11, 12	—	$37.78
33	335	11, 12	—	$37.78

6 fee rows in the bulletin attachment, PDF page 65.

98980Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least 1 real-time interactive communication with the patient or caregiver during the calendar month; first 20 minutes$20.26Clinical review

Units: first 20 minutes
Limits: once per calendar month
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$20.26
08	082	49	—	$20.26
09	All	11, 12	—	$20.26
10	100, 247	11, 12	—	$20.26
31	All	11, 12	—	$20.26
33	335	11, 12	—	$20.26

6 fee rows in the bulletin attachment, PDF page 66.

99453Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate); initial set-up and patient education on use of equipment$15.96Clinical review

Units: per procedure
Limits: once per 90 days
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$15.96
08	082	49	—	$15.96
09	All	11, 12	—	$15.96
10	100, 247	11, 12	—	$15.96
31	All	11, 12	—	$15.96
33	335	11, 12	—	$15.96

6 fee rows in the bulletin attachment, PDF page 67.

99454Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate); device(s) supply with daily recording(s) or programmed alert(s) transmission, 16- 30 days in a 30-day period$38.27Clinical review

Units: per procedure, minimum of 16 days
Limits: once per calendar month
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$38.27
08	082	49	—	$38.27
09	All	11, 12	—	$38.27
10	100, 247	11, 12	—	$38.27
31	All	11, 12	—	$38.27
33	335	11, 12	—	$38.27

6 fee rows in the bulletin attachment, PDF page 67.

99457Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring 1 real-time interactive communication with the patient/caregiver during the calendar month; first 20 minutes$20.74Clinical review

Units: first 20 minutes
Limits: once per calendar month
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$20.74
08	082	49	—	$20.74
09	All	11, 12	—	$20.74
10	100, 247	11, 12	—	$20.74
31	All	11, 12	—	$20.74
33	335	11, 12	—	$20.74

6 fee rows in the bulletin attachment, PDF page 68.

77387Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking, when performed$28.25Updated fee

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
31	ALL	11, 22	26	$28.25

1 fee row in the bulletin attachment, PDF page 68.

77402Radiation treatment delivery; Level 1 (eg, single-electron field, multiple-electron fields, or 2D photons), including imaging guidance, when performed$60.36Updated fee

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$60.36
31	ALL	11	—	$60.36

2 fee rows in the bulletin attachment, PDF page 68.

77407Radiation treatment delivery; Level 2, single-isocenter (eg, 3D or IMRT), photons, including imaging guidance, when performed$227.68Updated fee

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$227.68
31	ALL	11	—	$227.68

2 fee rows in the bulletin attachment, PDF page 69.

77412Radiation treatment delivery; Level 3, multiple isocenters with photon therapy (eg, 2D, 3D, or IMRT) or a single-isocenter photon therapy (eg, 3D or IMRT) with active motion management, or total skin electrons, or mixed-electron/photon field(s), including imaging guidance, when performed$325.80Updated fee

Units: per procedure
Limits: once per day
Post-op days: —
Prior authorization: No

Provider type	Specialty	Place of service	Modifiers	MA fee
01	183	22	—	$325.80
31	ALL	11	—	$325.80

2 fee rows in the bulletin attachment, PDF page 69.

Fee increases4 codes

Existing codes whose maximum fee rose on August 1, 2026.

77387modifier 26+80%

Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking, when performed

$15.73$28.25up $12.52

77402+181%

Radiation treatment delivery; Level 1 (eg, single-electron field, multiple-electron fields, or 2D photons), including imaging guidance, when performed

$21.50$60.36up $38.86

77407+601%

Radiation treatment delivery; Level 2, single-isocenter (eg, 3D or IMRT), photons, including imaging guidance, when performed

$32.50$227.68up $195.18

77412+640%

Radiation treatment delivery; Level 3, multiple isocenters with photon therapy (eg, 2D, 3D, or IMRT) or a single-isocenter photon therapy (eg, 3D or IMRT) with active motion management, or total skin electrons, or mixed-electron/photon field(s), including imaging guidance, when performed

$44.00$325.80up $281.80

End-dated codes73 codes

These stop being payable after July 31, 2026. Claims already authorised are accepted through July 31, 2027. Codes highlighted in green are DME or prosthetic codes.

27445
27468
33884
33889
33891
37220
37221
37222
37223
37224
37225
37226
37227
37228
37229
37230
37231
37232
37233
37234
37235
37500
52647
55700
75842
75956
75957
75958
75959
77014
77385
77386
77401
77417
91120
91122
92590
92591
92592
92593
92594
92595
92921
92925
92929
92934
92938
92944
92975
92977
94662
D9248
G6001
G6002
G6003
G6004
G6005
G6006
G6007
G6008
G6009
G6010
G6011
G6012
G6013
G6014
G6015
G6016
L6000
L6010
L6020
L8010
Q4106

Removed provider type, specialty and place of service5 rows

These combinations are no longer payable for the code shown, even though the code itself stays active.

Code	Modifier	Provider type	Specialty	Place of service
77387	—	01 (Inpatient Facility)	183 (Hospital Based Medical Clinic)	22 (Outpatient Hospital)
77387	—	31 (Physician)	All	11
77387	TC	01	183	22
77387	TC	31	All	11
77387	26	31	All	21 (Inpatient Hospital)

DME impact4 codes

This bulletin adds no new DME rates. Its only DME effect is that these four upper-limb prosthetic and breast prosthesis codes are end-dated after July 31, 2026, with previously authorised claims accepted through July 31, 2027. Everything else priced in the bulletin is billed by physicians, hospitals and laboratories rather than DME suppliers.

L6000End-dated

L6010End-dated

L6020End-dated

L8010End-dated

Nothing matches that search. Try the procedure code on its own.

Source: Pennsylvania Department of Human Services Medical Assistance Bulletin 99-26-04, issued July 10, 2026, attachment effective August 1, 2026. Fees apply to the fee-for-service delivery system and may differ from managed care organisation rates. Read the source bulletin.

Which Pennsylvania Medicaid DME Fee Schedule Should Providers Use?

Pennsylvania has two commonly referenced fee-schedule sources.

The online Medical Assistance fee schedule should be the first stop when you need current Fee-for-Service information. Pennsylvania DHS states that this database is updated daily.

The downloadable PROMISe outpatient schedule is useful when a supplier needs a large file for internal analysis, reimbursement modeling, system updates, or bulk code review. However, Pennsylvania updates that downloadable file quarterly, so changes made afterward may not appear in the saved version.

For billing operations, the practical approach is:

Use the downloadable file for bulk work and use the live Pennsylvania database when validating a specific claim.

This distinction becomes particularly important after a HCPCS update, modifier change, code end date, prior authorization revision, fee change, or new Medical Assistance Bulletin.

How to Read a Pennsylvania Medicaid DME Fee-Schedule Record

A Pennsylvania fee-schedule result contains more than an HCPCS code and a dollar amount.

Understanding the surrounding fields is often what separates a correctly priced claim from a denial.

Provider Type and Specialty

Durable Medical Equipment and Medical Supplies are primarily associated with Provider Type 25 in Pennsylvania Medicaid. The state’s provider type and specialty list identifies specialties including 220 Hearing Aid Dispenser, 250 DME/Medical Supplies, 251 Prosthetist, 252 Orthotist, and 253 Optician.

A code appearing on the schedule does not automatically mean every Provider Type 25 supplier can bill it. Match the fee-schedule line to the specialty under which the billing service location is actually enrolled.

HCPCS Code

The procedure code identifies the item or service being billed. Review all relevant results rather than automatically selecting the first line returned, because one HCPCS may appear under different provider types, specialties, places of service, or modifier combinations.

For a code-level example of how DME coding, documentation, payer rules, and reimbursement interact, see our HCPCS code E0601 billing guide.

Modifier

Modifiers can identify the circumstances under which equipment is furnished or priced.

Depending on the item and payer rules, DME modifiers may distinguish rental, purchase, replacement, new equipment, used equipment, rental month, or another billing condition.

Pennsylvania specifically warns that modifiers displayed in its fee-schedule database are reference information. The controlling Medical Assistance Bulletin or handbook should be reviewed when modifier requirements are unclear.

Medical Assistance Fee

The listed amount represents the established FFS price for that particular schedule configuration.

The amount should be read together with the provider type, specialty, place of service, modifier, and effective period.

A rate displayed for one configuration should not automatically be applied to another.

Place of Service

Place of service is another part of the billing combination.

Even when the HCPCS code itself is correct, using a POS that does not correspond with the payable configuration can create claim-processing problems.

Units and Limits

Some equipment and supplies are subject to minimum, maximum, frequency, age, or other utilization limits.

These limitations matter especially for recurring supplies, replacements, extended rental periods, accessories, and high-utilization items.

When the beneficiary requires more than an established Fee-for-Service limit, a Program Exception may need to be considered.

Prior Authorization

The fee schedule may provide PA information, but that indicator should not replace the applicable Pennsylvania DME bulletin or handbook.

The underlying authorization criteria may depend on the equipment category, medical necessity, rental duration, replacement circumstances, beneficiary characteristics, requested quantity, clinical documentation, or alternatives already attempted.

The Billing Combination That Matters

For production billing, treat a Pennsylvania Medicaid DME rate as this combination:

HCPCS + Provider Type + Specialty + POS + Modifier + Effective Date

Then determine whether authorization, service limits, medical necessity requirements, or a Program Exception applies.

This is safer than maintaining an internal rate file containing only:

HCPCS + Price

A simplified price file may be useful for estimates, but it can lose the billing conditions attached to the reimbursement amount.

Important Pennsylvania DME Changes in 2026

Pennsylvania has been active with DME policy updates during 2026.

Several equipment categories received new or revised prior authorization guidance, including manual hospital beds, orthopedic footwear, lower- and upper-extremity orthoses, thoracic-lumbar-sacral orthoses, pediatric adaptive seating, wheelchair cushions and accessories, standers, prosthetic components, specialized blood glucose meters, tracheostomy speaking devices, and other DME-related items.

Three changes deserve particular attention from billing teams.

2026 development	Why it matters
Medical Assistance Bulletin 99-26-02	Introduced the Qualitrac Provider Portal rollout for FFS prior authorization and Program Exception submissions
Medical Assistance Bulletin 99-26-04	Implemented 2026 HCPCS and related procedure-code changes effective August 1, 2026
Multiple 01-26-series DME bulletins	Updated clinical and documentation requirements for specific equipment categories

The practical takeaway is simple: if your authorization templates were built around 2025 requirements, do not assume they are still sufficient for every DME category in 2026.

MAB 99-26-04 Is a Change Bulletin, Not the Full Pennsylvania DME Fee Schedule

This point can prevent a major research mistake.

Medical Assistance Bulletin 99-26-04 updates Pennsylvania’s Medical Assistance Program Fee Schedule for annual HCPCS changes and other procedure-code revisions.

It addresses items such as code additions, end dates, provider-type or specialty changes, POS updates, modifiers, units, authorization changes, and selected fee adjustments.

It should not be treated as Pennsylvania’s complete DME reimbursement schedule.

A spreadsheet converted from the bulletin can accurately show what changed while still representing only a fraction of the DME codes available in the statewide fee database.

For a complete rate search, the Pennsylvania Medical Assistance fee-schedule database remains the better source.

Four DME-Related L-Codes Were End-Dated in 2026

One of the more important DME-specific details in the 2026 HCPCS update involves four L-codes:

L6000, L6010, L6020, and L8010.

Pennsylvania stopped approving new prior authorization requests for these end-dated codes after July 31, 2026.

There is, however, an important transition rule.

When one of these codes had already been authorized before the cutoff, providers should follow the authorization notice for the previously approved service. Pennsylvania allows qualifying claims using those previously authorized end-dated codes through July 31, 2027.

That means an end-dated code is not always replaced immediately on an existing authorization.

Before changing the HCPCS on a previously approved service, compare the claim with the authorization notice.

The fee adjustments contained in MAB 99-26-04 should also not be interpreted as a broad Pennsylvania DME rate increase. The bulletin covers multiple provider and service categories, not DME alone.

Prior Authorization and Pennsylvania’s Qualitrac DME Rollout

Pennsylvania is implementing the Qualitrac Prior Authorization Provider Portal in phases for Fee-for-Service prior authorization and Program Exception requests.

Durable Medical Equipment is included in Phase 4.

The DME rollout includes Provider Type 25 specialties 220, 250, 251, and 252, along with several other provider types involved in DME, appliance, supply, nutrition, prosthetic, or orthotic services.

DME registration and onboarding began July 30, 2026. Initial training took place August 14, with follow-up training scheduled for September 15.

As of this article’s review date, Pennsylvania states that portal use is not yet mandatory, although providers included in the rollout are encouraged to register and training is a required part of the implementation process.

Qualitrac applies to Fee-for-Service authorizations. It does not replace an MCO’s authorization system for a member enrolled in managed care.

What Information Is Needed for a DME PA or Program Exception?

Pennsylvania’s portal requirements show why authorization preparation should start before anyone opens the submission screen.

A DME team should have the beneficiary information, request type, place of service, service dates, ordering or prescribing provider, treating or servicing provider, diagnosis codes, HCPCS codes, required modifiers, and supporting clinical records available before submission.

The clinical documentation should explain why the equipment is necessary, not simply confirm that a physician ordered it.

That difference becomes particularly important with complex or high-cost equipment.

Example: Manual Hospital Beds

Pennsylvania’s 2026 manual hospital bed prior-authorization bulletin demonstrates the type of medical-necessity documentation reviewers may expect.

For authorization-sensitive hospital-bed requests, the record can need to address the beneficiary’s diagnosis, functional and ambulatory status, transfer ability, assistance required, positioning needs, relevant imaging, and PT or OT findings when applicable.

The documentation should connect the equipment to a functional need.

For example, if special positioning is required, the record should explain why an ordinary bed with pillows, wedges, or other common positioning methods cannot reasonably meet the beneficiary’s medical needs.

Example: Wheelchair Cushions and Accessories

Wheelchair cushions present a similar documentation challenge.

Pennsylvania guidance may require information about the beneficiary’s diagnoses, mobility-related activities of daily living, functional status, related wheelchair, equipment make or model, measurements, cushion specifications, PT or OT findings, skin-protection needs, positioning needs, and alternatives considered.

Replacement requests can also require information about the age and condition of the current equipment and whether repair remains a reasonable option.

For custom cushions, the documentation should establish why a standard or prefabricated product cannot meet the beneficiary’s needs.

These examples illustrate a broader DME rule: diagnosis alone rarely tells the complete medical-necessity story.

Prior Authorization vs. Program Exception

Prior authorization and Program Exception solve different problems.

Prior authorization determines whether a service must be approved before payment under the applicable Pennsylvania rule.

A Program Exception, or PE, may become relevant when the beneficiary medically requires an item or service beyond an established Fee-for-Service limitation.

For example, a supplier may have the correct HCPCS, modifier, POS, and rate but still encounter a denial because the requested quantity exceeded the permitted limit.

In that situation, the unresolved issue may be the absence of a required Program Exception rather than incorrect coding.

Pennsylvania Medicaid FFS vs. HealthChoices Managed Care

The reimbursement information in this guide is Pennsylvania Medical Assistance Fee-for-Service information. A beneficiary enrolled in HealthChoices or another Medicaid managed care arrangement may be subject to the plan’s own reimbursement agreement, authorization workflow, utilization rules, and claim-processing requirements.

Identify the beneficiary’s delivery system before relying on an FFS rate or starting an authorization. MAB 99-26-04 itself directs managed-care providers to the appropriate MCO for coding and billing questions.

Suppliers that also bill Medicare should keep those coverage rules separate as well. Our guide to DME items not covered by Medicare can help intake teams recognize when a Medicare coverage rule, not Pennsylvania Medicaid—is driving the payment decision.

Seven-Step Pennsylvania DME Claim Preflight

Confirm coverage. Determine whether the beneficiary is FFS or enrolled in managed care for the date of service.
Verify enrollment. Check the billing location, NPI, provider type, specialty, and ordering or prescribing provider.
Search the current fee schedule. Use the exact HCPCS and narrow the search using PT, specialty, and POS where possible.
Validate the schedule line. Check the fee, modifier, effective date, units, limits, and authorization reference.
Review the current policy. Read the applicable DME bulletin or handbook for authorization-sensitive services.
Match the approval to the claim. Make sure code, modifier, units, dates, provider data, and equipment agree with the authorization.
Retain the evidence. Keep the order, medical-necessity records, PA or PE notice, proof of delivery, and billing-support documents.

This workflow gives the billing team one consistent checkpoint before inventory already delivered becomes an unpaid claim.

Common Pennsylvania Medicaid DME Denials to Check First

Problem	What may have gone wrong	First action
Outdated reimbursement information	An older quarterly file was used after a change	Recheck the live Pennsylvania fee schedule
Wrong provider type or specialty	The HCPCS is payable, but not for the submitted enrollment combination	Compare the claim with the exact PT/specialty schedule line
POS mismatch	The submitted location does not match the payable configuration	Verify POS against the live record and billing guidance
Modifier mismatch	The rate was taken from a different modifier configuration	Confirm the applicable modifier rule
Missing PA	Authorization was required but not obtained	Review the current category-specific guidance
PA mismatch	Approved code, units, dates, or equipment differ from the claim	Compare the authorization notice line by line
Limit exceeded	Quantity or frequency is above the FFS limitation	Determine whether a Program Exception was required
End-dated code	An inactive HCPCS was used without transition authority	Check the effective date and authorization history
Enrollment problem	NPI, location, specialty, or ordering provider information does not align	Verify PROMISe enrollment information
Weak documentation	Records show a diagnosis but not the functional need	Rebuild the file around the applicable PA criteria
Wrong payer workflow	FFS requirements were applied to a managed-care beneficiary	Confirm the member’s delivery system

Provider Type 25 and Service-Location Checks

Pennsylvania DME suppliers should not overlook enrollment when troubleshooting a rate or denial. A valid procedure code and correct reimbursement amount cannot overcome an enrollment problem.

DHS NPI guidance for Pennsylvania Medical Assistance providers recommends that DME suppliers under Provider Type 25 secure an NPI for each physical site licensed by the Pennsylvania Department of Health. Before rebilling, confirm that the service location, NPI, provider type, specialty, and ordering or prescribing provider information align with Pennsylvania Medicaid records.

If you are establishing a new location or expanding into Pennsylvania, review our state-by-state DME licensing guide for Pennsylvania registration considerations before payer enrollment.

Frequently Asked Questions

Where can I find the current Pennsylvania Medicaid DME fee schedule?

Use the Pennsylvania Department of Human Services online Medical Assistance fee schedule for the most current Fee-for-Service information. The downloadable PROMISe schedule is useful for bulk data but is updated quarterly.

Why can the same HCPCS code show different Pennsylvania Medicaid rates?

Different schedule entries may apply to different provider types, specialties, places of service, modifiers, or effective periods. Match the reimbursement amount to the configuration used on the actual claim.

Does a fee on the schedule mean the equipment is automatically covered?

No. The schedule shows reimbursement information for a billing configuration. Eligibility, medical necessity, authorization, units, enrollment, documentation, and other program rules can still affect payment.

Does Pennsylvania Medicaid DME require prior authorization?

Some DME items do. Check the fee-schedule reference information and then review the current Pennsylvania DME bulletin or handbook for the complete criteria.

What happens when a patient needs more than the FFS limit?

Determine whether a Program Exception is required. The PE process may allow medically necessary services or items beyond an established Fee-for-Service limitation.

Does the Pennsylvania FFS fee apply to HealthChoices?

Not automatically. Managed care organizations operate under their own reimbursement arrangements and authorization requirements.

Is Qualitrac mandatory for Pennsylvania DME providers?

As of September 10, 2026, Pennsylvania DHS says portal use is not mandatory at this time. DME is included in Phase 4 of the rollout, and providers should follow the current onboarding and training instructions.

Can L6000, L6010, L6020, and L8010 still be billed?

Pennsylvania stopped approving new PA requests for these end-dated codes after July 31, 2026. Previously authorized services may continue under the applicable transition instructions, with qualifying claims accepted through July 31, 2027.

Why did my DME claim deny even though the fee schedule shows a price?

Start by comparing the actual claim with the exact schedule configuration. Check provider type, specialty, POS, modifier, units, effective date, authorization, beneficiary coverage, and enrollment information.

Turn the Fee Schedule Into a Pre-Bill Control

Pennsylvania Medicaid DME reimbursement depends on much more than the HCPCS rate listed in the fee schedule. Provider type, specialty, place of service, modifiers, service limits, authorization requirements, effective dates, and the member’s coverage all need to line up before the claim is submitted.

Building these checks into the billing workflow can help suppliers catch problems earlier, especially on high-cost equipment, rentals, replacements, and authorization-sensitive items. It also reduces the risk of finding a coding or eligibility issue only after the equipment has already been delivered.

For suppliers managing a high volume of Medicaid claims, consistent pre-bill review is especially important. An experienced DME billing service can support coding, prior authorization, documentation, eligibility verification, denial management, and reimbursement follow-up. If you want to discuss your current workflow, contact our DME billing team.

Pennsylvania Medicaid DME Fee Schedule 2026: Rates, Prior Authorization & Billing Guide

Pennsylvania Medicaid DME Fee Schedule 2026

Pennsylvania Medical Assistance 2026 HCPCS update

Which Pennsylvania Medicaid DME Fee Schedule Should Providers Use?

How to Read a Pennsylvania Medicaid DME Fee-Schedule Record

Provider Type and Specialty

HCPCS Code

Modifier

Medical Assistance Fee

Place of Service

Units and Limits

Prior Authorization

The Billing Combination That Matters

Important Pennsylvania DME Changes in 2026

MAB 99-26-04 Is a Change Bulletin, Not the Full Pennsylvania DME Fee Schedule

Four DME-Related L-Codes Were End-Dated in 2026

Prior Authorization and Pennsylvania’s Qualitrac DME Rollout

What Information Is Needed for a DME PA or Program Exception?

Example: Manual Hospital Beds

Example: Wheelchair Cushions and Accessories

Prior Authorization vs. Program Exception

Pennsylvania Medicaid FFS vs. HealthChoices Managed Care

Seven-Step Pennsylvania DME Claim Preflight

Common Pennsylvania Medicaid DME Denials to Check First

Provider Type 25 and Service-Location Checks

Frequently Asked Questions

Where can I find the current Pennsylvania Medicaid DME fee schedule?

Why can the same HCPCS code show different Pennsylvania Medicaid rates?

Does a fee on the schedule mean the equipment is automatically covered?

Does Pennsylvania Medicaid DME require prior authorization?

What happens when a patient needs more than the FFS limit?

Does the Pennsylvania FFS fee apply to HealthChoices?

Is Qualitrac mandatory for Pennsylvania DME providers?

Can L6000, L6010, L6020, and L8010 still be billed?

Why did my DME claim deny even though the fee schedule shows a price?

Turn the Fee Schedule Into a Pre-Bill Control

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Pennsylvania Medicaid DME Fee Schedule 2026

Pennsylvania Medical Assistance 2026 HCPCS update

Which Pennsylvania Medicaid DME Fee Schedule Should Providers Use?

How to Read a Pennsylvania Medicaid DME Fee-Schedule Record

Provider Type and Specialty

HCPCS Code

Modifier

Medical Assistance Fee

Place of Service

Units and Limits

Prior Authorization

The Billing Combination That Matters

Important Pennsylvania DME Changes in 2026

MAB 99-26-04 Is a Change Bulletin, Not the Full Pennsylvania DME Fee Schedule

Four DME-Related L-Codes Were End-Dated in 2026

Prior Authorization and Pennsylvania’s Qualitrac DME Rollout

What Information Is Needed for a DME PA or Program Exception?

Example: Manual Hospital Beds

Example: Wheelchair Cushions and Accessories

Prior Authorization vs. Program Exception

Pennsylvania Medicaid FFS vs. HealthChoices Managed Care

Seven-Step Pennsylvania DME Claim Preflight

Common Pennsylvania Medicaid DME Denials to Check First

Provider Type 25 and Service-Location Checks

Frequently Asked Questions

Where can I find the current Pennsylvania Medicaid DME fee schedule?

Why can the same HCPCS code show different Pennsylvania Medicaid rates?

Does a fee on the schedule mean the equipment is automatically covered?

Does Pennsylvania Medicaid DME require prior authorization?

What happens when a patient needs more than the FFS limit?

Does the Pennsylvania FFS fee apply to HealthChoices?

Is Qualitrac mandatory for Pennsylvania DME providers?

Can L6000, L6010, L6020, and L8010 still be billed?

Why did my DME claim deny even though the fee schedule shows a price?

Turn the Fee Schedule Into a Pre-Bill Control

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