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Codes/Fee Schedules

Fee Schedules and Other Information for Claims Processing
 

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.

Please refer to the Imminent Harm Code List for services that require a Prior Authorization.