Pennsylvania’s Department of Human Services (DHS) runs an official outpatient fee schedule where you can search procedure codes, provider types, specialties, pricing, modifiers, and places of service. For healthcare providers, medical billers, and practice administrators, it’s the first stop before touching any Medical Assistance claim.
Here’s the thing — not every 2027 rate is published yet. Before building any billing workflow around a specific number, check the current official schedule and the latest Medical Assistance bulletins. Confirmed changes only.
What Is the Pennsylvania Medicaid Fee Schedule?
At its core, the Pennsylvania Medicaid fee schedule lists established Medical Assistance payment amounts for covered services under the fee-for-service program. It gives participating providers a published payment amount tied to a specific procedure or service.
What actually applies to a claim is another matter. That depends on:
- Procedure or service code
- Provider type and specialty
- Required pricing or billing modifiers
- Place of service
- Coverage and authorization requirements
- The effective date of the fee or policy
Think of it as a reference, not a guarantee. Submitting a claim still requires following all applicable Medical Assistance policies and processing requirements — the schedule alone doesn’t get you paid.
Is the Pennsylvania Medicaid Fee Schedule for 2027 Available?
Short answer: not fully. As of October 13, 2026, official resources don’t confirm that a comprehensive, finalized 2027 fee schedule covering all Pennsylvania Medicaid services has been published.
Use the current official schedule to verify rates and keep an eye on DHS announcements for anything taking effect in 2027. Plugging in an estimated annual increase or borrowing another state’s reimbursement figure isn’t a workaround — it’s a billing risk.
Curious how Pennsylvania’s approach stacks up elsewhere? This Medicaid fee schedule by state overview gives useful context before you go deep on Pennsylvania-specific lookups.
One confirmed 2026 update worth knowing: Pennsylvania published an official notice in October 2026 covering increased fees for certain direct nursing services from home health agencies. Effective date was July 1, 2026 — not January 1, 2027.
The notice covers two services:
| Procedure Code | Service | Modifier | New Fee |
|---|---|---|---|
| G0299 | Direct skilled nursing by a registered nurse in a home health or hospice setting, per 15 minutes | U8 | $176 |
| G0300 | Direct skilled nursing by a licensed practical nurse in a home health or hospice setting, per 15 minutes | U8 | $176 |
These figures come directly from the published state notice. Verify the current schedule, effective-date instructions, provider requirements, and billing guidance before applying them to a claim. This change covers two specific codes — it doesn’t set a standard rate for all home health or all Pennsylvania Medicaid services.
Official source: Pennsylvania Bulletin — Medical Assistance Program Fee Increases for Direct Nursing Services.
How to Check Pennsylvania Medicaid Reimbursement Rates
Pennsylvania’s official outpatient fee schedule is the right tool. No shortcuts here — run the actual lookup:
- Open the Pennsylvania Medical Assistance Outpatient Fee Schedule.
- Enter the most specific search details available — procedure code or description.
- Select the relevant provider type, specialty code, and place of service.
- Review the procedure information, pricing amount, and listed modifiers.
- Pull the applicable Medical Assistance bulletin or provider handbook for billing instructions, restrictions, and authorization requirements.
- Confirm the fee and policy cover the service’s actual date of delivery.
A full fee schedule download is also available through the tool. Broad searches run slower — a specific code or provider detail gets you there faster.
Understanding Fee Schedule Fields
Misreading a field is one of the more avoidable billing mistakes. Know what you’re looking at before acting on it.
Provider type tells you which type of provider is permitted to bill for that service.
Specialty code identifies the applicable provider specialty.
Procedure code identifies what’s being billed. Depending on the service, it comes from CPT or HCPCS.
Procedure price amount shows the established Medical Assistance fee for that schedule entry. A $0 listing doesn’t automatically mean the service is free or nonpayable — Pennsylvania’s fee schedule legend specifically instructs users to contact the appropriate program office when that comes up.
Modifiers are additional codes that affect billing or pricing. Which one applies depends on the service and applicable program instructions.
Place of service identifies the permitted setting.
For complete definitions, go to the official Pennsylvania fee schedule legend. Don’t guess at terminology.
CPT and HCPCS Codes for Pennsylvania Medicaid
CPT and HCPCS codes are how procedures, services, supplies, and other items get reported on claims. Before submitting anything, verify the code is appropriate for the service performed and accepted under Pennsylvania Medical Assistance requirements.
Run through this checklist before the claim goes out:
- Correct procedure code and code-set version for the service date
- Provider type and specialty eligible to bill the code
- Modifier requirement confirmed
- Place of service permitted
- Prior authorization, documentation, or other conditions checked
- Any code update or fee adjustment that’s taken effect
A code showing up in a reference tool doesn’t establish coverage or promise reimbursement. Pennsylvania’s policies and billing instructions govern — the code lookup is just the starting point.
For patients trying to find out what their coverage actually includes, checking Pennsylvania Medicaid income limits is a useful first action before wading into procedure-level info.
Pennsylvania Medicaid Fee Schedule Updates for 2027
Fee schedule changes ripple through reimbursement, claims processing, and revenue-cycle planning. Unofficial rate tables go stale fast — the only reliable source is official DHS announcements.
The Pennsylvania DHS Office of Medical Assistance Programs posts program updates, bulletins, and provider notices through its What’s New at OMAP page. That’s where confirmed changes land first.
For 2027, billing teams need to work through this systematically:
- Review new Medical Assistance bulletins and their effective dates.
- Check fee schedule entries for affected procedure codes.
- Update billing-system fee tables when an official change applies.
- Confirm modifier, authorization, and documentation details.
- Test claims for affected services and review remittance advice for payment discrepancies.
- Retain the applicable official notice or schedule version for audit documentation.
Don’t apply a newly announced fee to dates of service outside its authorized effective period — unless the official instructions specifically say otherwise.
Fee-for-Service vs. Medicaid Managed Care
Pennsylvania Medicaid runs on both fee-for-service and managed care. They work differently. Treating them as the same thing causes billing problems.
Under fee-for-service, Pennsylvania’s Medical Assistance fee schedule and billing policies are the primary references for covered services billed directly under that system. Under managed care, you also need the relevant health plan’s provider contract, reimbursement terms, authorization requirements, and claims procedures. The published state fee schedule is not automatically the payment rate for managed care claims.
Before quoting a reimbursement payment or challenging an underpayment, nail down 4 points: the member’s coverage arrangement, the billing provider, the service date, and the applicable payment rules. Getting any of those wrong is how disputes start.
What to Do If a Procedure Code or Fee Is Missing
Can’t locate the code? Fee looks wrong? Don’t draw conclusions from the search result alone.
Work through it methodically:
- Search using the exact code and a relevant description
- Confirm provider type, specialty, modifier, and place of service
- Review the applicable Medical Assistance bulletins and handbooks
- Check whether the service falls under a separate program, waiver, or authorization process
- Contact Pennsylvania’s Provider Service Center if nothing resolves it
Pennsylvania lists the Bureau of Fee-for-Service Programs Service Center at 1-800-537-8862 for provider assistance. Confirm the latest contact info and follow DHS’s phone menu before assuming anything.
Frequently Asked Questions
Where can I find the Pennsylvania Medicaid Fee Schedule for 2027?
Pennsylvania’s official Medical Assistance Outpatient Fee Schedule is the right place. Verify the latest rates and check DHS bulletins for confirmed 2027 updates before relying on anything specific.
Has Pennsylvania published all Medicaid rates for 2027?
Not as of October 2026. A complete, finalized 2027 schedule covering all services hasn’t been confirmed. Use the current schedule and check for updates.
How do I look up a Pennsylvania Medicaid CPT code?
Open the official outpatient fee schedule, search by procedure code or description, then review provider type, specialty, modifiers, place of service, and program instructions before doing anything with the result.
Does the Pennsylvania Medicaid fee schedule show the final payment for every claim?
No. The listed fee is the schedule entry — actual payment depends on program rules, eligibility, coverage, authorization, claim details, and a range of other requirements.
What is the Pennsylvania Medicaid home health nursing fee increase?
A state notice from October 2026 lists $176 for direct nursing services billed under G0299 and G0300 with modifier U8, effective July 1, 2026. Check the official notice and current schedule for full billing conditions before applying it.
Are Pennsylvania Medicaid fee-for-service and managed care rates the same?
Not necessarily — and that assumption causes real billing problems. Check the applicable fee-for-service rules or your managed care plan contract before determining the rate.
Where can providers find Pennsylvania Medicaid billing updates?
The DHS Office of Medical Assistance Programs updates page and Medical Assistance bulletins. That’s the authoritative source — everything else is downstream of it.
What should I do if the fee schedule lists $0 for a service?
Check the official fee schedule legend and contact the appropriate program office. A $0 entry doesn’t mean the service is free, covered, or nonpayable — it means you need more information.
Conclusion
The Pennsylvania Medicaid fee schedule isn’t a document you read once and file away. Rates change mid-year. Bulletins drop unexpectedly. Managed care adds a separate set of rules on top of everything else.
A complete 2027 schedule still hasn’t been confirmed, so verify rates one by one and stay current with DHS bulletins. The billing teams that stay out of trouble aren’t doing anything magical — they’re just not assuming.
Disclaimer: This guide is for general educational purposes only and is not legal, medical, or reimbursement advice. Rates and billing rules may change. Always confirm latest requirements with the Pennsylvania Department of Human Services and the applicable Medicaid plan before billing.