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$29/mo7-day free trialThese pages show common-procedure samples per category. The complete all-codes Pennsylvania schedules export as CSV with the Rates plan.
- Every code on all 51 published schedules
- Full-schedule CSV export and state network lists
- Email alerts when a state changes its rates
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How Pennsylvania pays
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.
Pennsylvania's published schedules by category
Codes on the current schedule, the newest effective date, the median published rate as a percentage of national Medicare where a comparator exists, and one recognizable procedure's rate per category. Open a category for its common-procedure table.
| Category | Codes | Effective | Median % of Medicare | Example rate | PA required |
|---|---|---|---|---|---|
| Physician | 4,676 | Aug 2026 | 48.6% | $35.00 Office visit, established patient, low complexity (20-29 min) (99213) | -- |
| Lab & Imaging | 1,500 | Aug 2026 | 80% | $23.64 Chest X-ray, 2 views (71046) | -- |
| DME & Supplies | 1,408 | Jan 2026 | 56.1% | $934.37 Continuous positive airway pressure (cpap) device (E0601) | -- |
| Vision | 40 | Aug 2026 | 92% | $89.90 Eye exam, new patient, comprehensive (92004) | -- |
| Behavioral Health | 26 | Jan 2026 | 24.7% | $52.00 Psychotherapy, 60 minutes (90837) | -- |
| State-Specific Services | 62 | Nov 2025 | 75.8% | -- | -- |
| Dental | Pennsylvania's dental Medicaid rates live in the dental section, with their own per-state page. | ||||
Pennsylvania also publishes 1 drugs code (Jul 2009), 24 hearing codes (Aug 2019), 4 transport codes (Feb 2007), too few or too old to summarize here.
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.
Where Pennsylvania publishes its fee schedules
- Publisher
- Pennsylvania Department of Human Services, Office of Medical Assistance Programs (DHS)
- Program
- Pennsylvania Medical Assistance
- Official source
- https://www.humanservices.dhs.pa.gov/OUTPATIENTFEESCHEDULE/
- Last checked
- Aug 21, 2026
ProviderSignal collects every category from the state's publication, standardizes the rows and labels each code in its own plain language. Rates are the published amounts; the state's page remains the legal source.
These are common-procedure samples. The complete Pennsylvania schedules, every category and every code, export as CSV on the Rates plan.
Compare Pennsylvania nationally
Frequently asked questions
Does Pennsylvania publish a Medicaid fee schedule?
Yes. Pennsylvania publishes 7,712 Medicaid fee-for-service procedure rates across 6 service categories, effective through Aug 2026, all collected and normalized here with plain-language procedure names. Pennsylvania Department of Human Services, Office of Medical Assistance Programs (DHS) publishes Pennsylvania's Medicaid fee schedules for Pennsylvania Medical Assistance. One thing to know about how Pennsylvania pays: 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.
Who publishes Pennsylvania's Medicaid fee schedule?
Pennsylvania Department of Human Services, Office of Medical Assistance Programs (DHS) publishes Pennsylvania's Medicaid fee schedules for Pennsylvania Medical Assistance. The state's own fee-schedule page is https://www.humanservices.dhs.pa.gov/OUTPATIENTFEESCHEDULE/. ProviderSignal collects every category from it, standardizes the rows and re-checks the source on a rolling cadence (last checked Aug 21, 2026).
What does Pennsylvania Medicaid pay for common services?
An established-patient office visit (99213) pays $35.00, a two-view chest X-ray (71046) $23.64 and a CPAP device (E0601) $934.37. Every figure is the state's published fee-for-service amount for the code's benchmark locality; managed-care plans can pay differently. The category pages list common procedures with plain-language names, and the complete all-codes schedules export as CSV on the Rates plan.
How do Pennsylvania's Medicaid rates compare with Medicare?
Pooled across categories with a national Medicare comparator, Pennsylvania's published rates run a median 55.5% of the Medicare amount, ranking 49 of 49 jurisdictions with a comparable basis.
What service categories does Pennsylvania publish?
Physician (4,676 codes), Lab & Imaging (1,500 codes), DME & Supplies (1,408 codes), Vision (40 codes), Behavioral Health (26 codes), State-Specific Services (62 codes). Dental rates have their own section with per-state pages.
How current are these rates?
Rates come from Pennsylvania's currently published fee schedules, the newest effective Aug 2026, and are re-collected on a rolling monthly cadence. This page updates automatically after each collection sweep.