Pennsylvania Medicaid Rates: The DHS Outpatient Fee Schedule

Pennsylvania’s Medicaid program is administered by the Department of Human Services (DHS) — Office of Medical Assistance Programs, with a public, searchable outpatient fee schedule at humanservices.state.pa.us. Full bulk downloads of the fee schedule require a provider login, but individual code lookups are publicly searchable.

What’s currently published

Current published rates tracked by MedicaidBench:

• 90791 (initial psychiatric diagnostic evaluation): $26.25 per encounter (effective 2023-10-01)
• 90837 (individual psychotherapy, ~60 min): $52.00 per session (effective 2025-11-12)
• 97153 (ABA treatment by technician, per 15 min): $15.76 (effective 2023-10-01)

Pennsylvania’s published rate for 90791 is notably lower than most other states MedicaidBench tracks for the same code — a reminder that behavioral health reimbursement doesn’t follow a predictable regional pattern, and a rate that looks like an outlier is worth confirming directly against the source rather than assuming a data error.

Format and access

The search-based public interface makes it easy to check a single code but harder to get a full picture across many codes at once without either an enrolled-provider login or a tool that’s already ingested the full dataset. This “single lookup vs. bulk access” split is common among states that treat the full fee schedule as provider-facing infrastructure rather than a public dataset.

What to watch for

The recent effective date on 90837 (November 2025) relative to 90791 and 97153 (both October 2023) suggests Pennsylvania has actively revisited its psychotherapy rate more recently than some adjacent behavioral health codes — worth watching if your billing mix leans toward one code family over another.

Keeping current

Because Pennsylvania’s public interface is search-based rather than a downloadable master file, tracking rate history across many codes over time isn’t practical through the public tool alone. MedicaidBench ingests and tracks Pennsylvania’s published rates continuously, preserving effective dates so historical comparisons don’t require re-searching the portal code by code.