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.
OPPS Fee Schedules: For Outpatient services billed on a UB-04 claim
High Tech Radiology: Requires a MedSolutions Prior Authorization
2013 - 2014 Radiology is included in the CPT Fee Schedule (top of this page)
ICD-9 Surgical Procedure Codes Requiring Prior Authorization
Code List (11/21/2014)
Code List (12/31/2013)
Code List (07/03/2013)
Dental Procedures Fee Schedule
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)
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.