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Claims Processing

last modified 02/09/2016 - 03:57 PM

Fee Schedules and Other Information for Claims Processing


Fee Schedules:    CPT Codes; Durable Medical Equipment (DME); HCPCS; Lab; Radiology; Ladies First; PAC 8 (Deleted Codes) & PAC 9 (Non Covered codes); Vision

  Please note that the tabs for the 2014 Fee Schedule have been modified.  Please read the Index page for more info.

 2016 Fee Schedules  

 2015 Fee Schedules

 2014 Fee Schedules

  2013 Fee Schedules

  2012 Fee Schedules


OPPS Fee Schedules:    For Outpatient services billed on a UB-04 claim 

  2016 OPPS Fee Schedules  

 2015 OPPS Fee Schedules

  2014 OPPS Fee Schedules

  2013 OPPS Fee Schedules

  2012 OPPS Fee Schedules


High Tech Radiology:    Requires a MedSolutions Prior Authorization

  2013 - 2014 Radiology is included in the CPT Fee Schedule (top of this page)

  2012 Radiology


ICD-9 PCS Codes Requiring Prior Authorization                                                                  ICD-10  PCS codes Requiring Prior Authorization

  Code List    (11/21/2014)                                                                                                       Code List (For services beginning 10/01/15; Posted 9/23/2015)

  Code List   (12/31/2013)

  Code List   (07/03/2013)


ICD-9 PCS  Codes  Non Covered or Inactive                                                                   ICD-10 PCS Codes Non Covered or Inactive

   ICD 9 Codes (Revised/Posted 10/01/2015)                                                                       ICD 10 Codes (Revised/Posted 10/01/2015)


 Dental Procedures Fee Schedule 

  January 1, 2015          (For services beginning 1/1/15; Revised/Posted (11/3/2015)         

  January 1, 2015        (For services beginning 1/1/15; Revised/Posted (10/1/2015)

   January 1, 2015       (For services beginning 1/1/15; Revised/Posted (9/16/2015)

  January 1, 2014        (For services beginning 1/1/14; Revised/Posted 05/05/15)

  November 1, 2013    (For services beginning 11/1/13; Revised/Posted 11/20/13)

  January 1, 2013        (For services beginning 01/01/13; Posted 4/5/13)

  January 1, 2011        (For services beginning 01/01/11; Posted 05/23/11)


Non-Emergency Medical Transportation (NEMT) Fee Schedule

  Per Member Per Month    (Valid for dates of service on/after 7/1/2012)

  2011 Fee Schedule          (Valid for dates of service through 6/30/2012)



 Urine Drug Testing Update (Posted 6/1/2015)

Hub & Spoke Health Home Rates  (Posted 2/6/14)

Children's Personal Care Services (Posted 6/12/14)

 Note: CPT and CDT codes, descriptions and other data only are copyright 2014 American Medical Association (AMA) and American Dental Association (ADA), respectively. All rights reserved. CPT is a registered trademark of the AMA. CDT is a registered trademark of the ADA. Applicable FARS and DFARS Restrictions apply to government use. The AMA and ADA assume no liability for data contained or not contained herein.



NOTE: Effective for dates of service  July 1, 2009 to October 31, 2013, Medicaid rates paid to some providers were reduced by 2%. The reduction was captured in the last step of claims processing and not reflected in the rates posted here. The remittance advice (RA) will state that the payment is a reduced amount of 2% from the posted DVHA fee schedules.