Department of Human Services Notice

pa-56-30-1059: 2026 Healthcare Common Procedure Coding System updates; fee adjustments and other procedure code changes

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Summary

The Department of Human Services (Department) announces changes to the Medical Assistance (MA) Program Fee Schedule. These changes are effective for dates of service on and after August 1, 2026. The Department is adding and end-dating procedure codes as a result of the 2026 updates published by the Centers for Medicare & Medicaid Services to the Healthcare Common Procedure Coding System (HCPCS) and as a result of clinical review. The Department is also adding other procedure codes and making changes to procedure codes currently on the MA Program Fee Schedule, to include setting limitations and making fee adjustments. As follows, some of the procedure codes being added to the MA Program Fee Schedule will require prior authorization. Procedure Codes Being Added or End-dated The Department is adding the following procedure codes and procedure code and modifier combinations to the MA Program Fee Schedule as a result of the 2026 HCPCS updates. These procedure codes may include the modifiers RT (right), LT (left), 50 (bilateral), 80 (assistant surgeon), SG (Ambulatory Surgical Center/Short Procedure Unit facility support component), TC (technical component), 26 (professional component), QW (Clinical Laboratory Improvement Amendments waived test) and FP (family planning). Procedure Codes and Modifiers 27458 (RT) 27458 (LT) 27458 (50) 27458 (80) (RT) 27458 (80) (LT) 27458 (80) (50) 27713 (SG) 27713 (RT) 27713 (LT) 27713 (50) 27713 (80) (RT) 27713 (80) (LT) 27713 (80) (50) 33882...

The agency’s own summary, as published.

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