PA Medical Assistance/MEDICAID Pharmacy Services Billing 

Looking to get enrolled as a Medicaid Provider? See our member's only guide below!

PPA Guide to Navigating Medicaid Enrollment for Pharmacists

Read the Medicaid Pharmacy Workgroup Press Release HERE

DHS Medical Assistance Bulletin - Pharmacist Enrollment in the Medical Assistance Program

PA DHS Medical Assistance Bulletin (10-24-02)

Issued on 2.1.2024 and effective 3.1.2024.

PURPOSE: The purpose of this bulletin is to advise licensed pharmacists that they may enroll in the Medical Assistance (MA) Program to provide services to MA beneficiaries. 

SCOPE: This bulletin applies to pharmacists enrolled or seeking to enroll in the MA Program to render services to MA beneficiaries. Pharmacist billing and payment in the fee-for-service delivery system will be addressed in a separate bulletin. Pharmacists should direct questions about credentialing or rendering services to MA beneficiaries in the managed care delivery system to the appropriate managed care organization.

IMPORTANT REMINDER: All providers must revalidate the Medical Assistance (MA) enrollment of each service location every 5 years. Providers should log into PROMISe to check the revalidation dates of each service location and submit revalidation applications at least 60 days prior to the revalidation dates. Enrollment (revalidation) applications may be found at: https://www.dhs.pa.gov/providers/Providers/Pages/PROMISe-Enrollment.aspx.

Read full MAB 10-24-02 on line HERE 

Medical Assistance Program Fee Schedule: Procedure Code Additions and Deletions for Pharmacist Services

Pennsylvania Bulletin, Volume 54, Issue 6

[54 Pa. B. 699]

Published 2.10.2024, effective March 1, 2024.

In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Human Services (Department) announces the addition and end-dating of the following procedure codes to and from the Medical Assistance (MA) Program Fee Schedule for pharmacist services. These changes are effective for dates of service on and after March 1, 2024.

Read full 54 Pa.B 699 HERE.

Medical Assistance (MA) Program Fee Schedule: FFS Pharmacist Billing Procedures. 

PA DHS Medical Assistance Bulletin (01-24-01, 08-24-02, 10-24-03, 24-24-01,31-24-02)

Issued 2.13.2024, effective March 1, 2024

Beginning March 1, 2024, the Department will enroll pharmacists as PT 10 (Mid-Level Practitioner)/Spec 247. As a result, the PT 24/Spec 247 will be closed. DHS is making the many updates to the MA Program Fee Schedule, effective with dates of service on and after March 1, 2024.

Read the full DHS MAB 01-24-01, 08-24-02, 10-24-03, 24-24-01, 31-24-02 HERE.

Provider Enrollment Training for Pharmacists Training Feb. 15, 2024

The PA Department of Human Services (DHS) held a training session for pharmacists wishing to enroll in the PA Medical Assistance/Medicaid program. The training session was approximately two hours and will be recorded. Participants will have the ability to ask questions using the chat feature which will be monitored by DHS staff. A link to the recording will be available by visiting, here

DHS Training for Pharmacist Provider Enrollment Training
Visit the website HERE for the application and link to the recording of the training. (Scroll to 10- Midlevel Practitioner)

Pharmacists Provider Enrollment Training FAQs (as of 4/15/2024)

DHS Resources: 

PA DHS Provider Enrollment Information Webpage

PA Online Provider Enrollment Portal (PROMISe)

MA Providers Contact Info