Every state, kept current
The Rates plan
$29/mo7-day free trialThe table on this page is a common-procedure sample. The full Pennsylvania state-specific services schedule has 62 codes.
- Every code on all 51 published schedules
- Full-schedule CSV export and state network lists
- Email alerts when a state changes its rates
$29/mo after the trial. Cancel anytime.
Published codes
62
state-specific and temporary HCPCS codes on the 2025 schedule
Median % of Medicare
75.8%
vs national Medicare, GPCI-neutral
Effective vintage
2025
latest effective year on the schedule
Pennsylvania publishes facility schedules (including inpatient rate files) alongside its professional fee schedule. Facility-grain rows keep their published rates but are excluded from Medicare-percentage comparisons.
Common state-specific and temporary HCPCS codes and what Pennsylvania Medicaid pays
A curated sample of recognizable procedures from the 62-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.
| Code | Procedure | Pennsylvania rate | % of Medicare |
|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | $57.00* | -- |
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
- Pennsylvania Medicaid fee schedule 2025, all categories
- Pennsylvania physician fee schedule · 4,676 codes
- Pennsylvania lab & imaging fee schedule · 1,500 codes
- Pennsylvania dme & supplies fee schedule · 1,408 codes
- Pennsylvania vision fee schedule · 40 codes
- Pennsylvania behavioral health fee schedule · 26 codes
- Pennsylvania hearing fee schedule · 24 codes
State-Specific Services rates in neighboring states
Frequently asked questions
What does Pennsylvania Medicaid pay for state-specific and temporary HCPCS services?
Pennsylvania Medicaid publishes 62 state-specific and temporary HCPCS code rates effective 2025, paying a median 75.8% of the national Medicare amount for the same services. The schedule covers clinic and screening encounters, telehealth facility fees, personal care, and other C, Q, S and T codes. 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 state-specific services rates compare with Medicare?
Across state-specific services codes with a national Medicare comparator, Pennsylvania Medicaid pays a median 75.8% of the Medicare amount (GPCI-neutral national comparison). Individual codes vary widely, so check the per-code percentage in the table.
Do state-specific and temporary HCPCS 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 2025), 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.