Pennsylvania Medicaid Lab & Imaging Fee Schedule 2026

Pennsylvania Medicaid publishes 1,500 lab & imaging procedure rates effective 2026, paying a median 88.5% of the national Medicare amount for the same services. This page shows published rates for common lab & imaging procedures with plain-language descriptions and, where a comparator exists, each rate as a percentage of national Medicare.

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The table on this page is a common-procedure sample. The full Pennsylvania lab & imaging schedule has 1,500 codes.

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Published codes

1,500

Lab & Imaging procedures on the 2026 schedule

Median % of Medicare

88.5%

vs national Medicare, GPCI-neutral

Effective vintage

2026

latest effective year on the schedule

Common lab & imaging procedures and what Pennsylvania Medicaid pays

A curated sample of recognizable procedures from the 1,500-code schedule. Rates are the state's published fee-for-service amounts; the percentage compares each rate with the national Medicare amount for the same code.

CodeProcedurePennsylvania rate% of Medicare
70110Jaw (mandible) X-ray, 4 or more views$27.5063.8%
70140Facial bone X-ray, under 3 views$27.4486.5%
70160Nasal bone X-ray$19.0050.8%
70220Sinus X-ray, 3 or more views$33.8889.8%
70360Neck soft tissue X-ray$17.5056.3%
70450CT scan of the head without contrast$116.75109.6%
70480CT scan of the eye socket or inner ear without contrast$173.43109.5%
70486CT scan of the face and sinuses without contrast$130.00101.4%
70491CT scan of neck soft tissue with contrast$137.5075%
70551MRI of the brain without contrast$337.61172.8%
70553MRI of the brain without then with contrast$339.00107%
71045Chest X-ray, 1 view$15.4861%
71046Chest X-ray, 2 views$23.6471.5%
71047Chest X-ray, 3 views$30.2173.5%
71048Chest X-ray, 4 or more views$32.4371.9%
71100Rib X-ray, one side$26.5073.5%
71250CT scan of the chest without contrast$133.59100.7%
71260CT scan of the chest with contrast$145.1587.1%
71275CT angiography of the chest$305.97109.1%
72040Neck (cervical) spine X-ray, 2-3 views$26.5066.7%
72070Mid-back (thoracic) spine X-ray, 2 views$30.9493.6%
72100Lower back (lumbar) spine X-ray, 2-3 views$32.5380.5%
72110Lower back (lumbar) spine X-ray, 4 or more views$36.6268.5%
72125CT scan of the neck (cervical) spine without contrast$133.59102.3%
72131CT scan of the lower (lumbar) spine without contrast$138.59106.7%

Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * show the schedule's representative published variant.

More Pennsylvania Medicaid fee schedules

Lab & Imaging rates in neighboring states

Frequently asked questions

What does Pennsylvania Medicaid pay for laboratory tests and imaging?

Pennsylvania Medicaid publishes 1,500 lab & imaging procedure rates effective 2026, paying a median 88.5% of the national Medicare amount for the same services. The schedule covers blood panels, urinalysis, X-rays, CT, MRI, and ultrasound. The table on this page shows published rates for common procedures; the complete all-codes schedule is available as a CSV download with a ProviderSignal Rates subscription.

How do Pennsylvania's lab & imaging rates compare with Medicare?

Across lab & imaging codes with a national Medicare comparator, Pennsylvania Medicaid pays a median 88.5% of the Medicare amount (GPCI-neutral national comparison). Individual codes vary widely, so check the per-code percentage in the table.

Do lab & imaging services need prior authorization in Pennsylvania?

Pennsylvania does not publish prior-authorization indicators on this fee schedule, so PA requirements must be confirmed through the state's provider manual or portal. Absence of a flag here means "not published", never "no PA required".

Where do these rates come from?

Directly from Pennsylvania's published Medicaid fee-for-service schedule (effective 2026), collected and normalized by ProviderSignal across all 50 states + DC. Rates are re-collected on a rolling schedule and this page updates automatically. Procedure descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.

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