Codes/Fee Schedules

Fee Schedules and Other Information for Claims Processing
All fee schedules (excluding OPPS below) can be found on the Vermont Medicaid portal. 

 

Fee schedule information is updated on a monthly basis. Information such as coverage or prior authorization requirements may be updated throughout the month, but will not be reflected in the fee schedules until the next monthly update. For the most current information regarding changes to coverage or prior authorization requirements, please refer to the weekly banner pages.

The DVHA perform code reviews on a quarterly or annual basis depending on the type. Coverage reviews can be initiated with receipt of a written prior authorization (PA) request from a Vermont Medicaid enrolled provider for a Vermont Medicaid member.

The DVHA does not review request for coverage by a manufacturer, a manufacturer’s representative, a Durable Medical Equipment vendor, or other third parties.

Refer to the Fee Schedule for information on the code coverage and if the code requires a prior authorization. Questions about this policy can be directed to the DVHA Clinical Operations Unit at 802-879-5903.

 

Department of Vermont Health Access

280 State Drive
Waterbury, Vermont 05671-1010
Phone: 802-879-5900
Fax: 802-241-0260

Department Contact List for customer service, program telephone and fax numbers, and staff email

Hours of Operation: Monday-Friday (Excluding Holidays) 7:45am - 4:30pm

Public Record Requests
Kelly Provost
DVHA Public Records Officer
AHS.DVHALegal@Vermont.gov
Visit the Agency of Administration site for the Public Records Database

Report Medicaid Fraud, Waste, and Abuse