MedicaidReimbursementHigh impact
Rate Increase for Certain School-Based Services Covered Under an IEP/IFSP
Maryland Medicaid·MD · Psychiatry, Pediatrics, Speech Therapy +2 more·Provider Transmittal
Effective date
Nov 1, 2021
We identified it
Jun 20, 2026
Summary
Effective November 1, 2021, Maryland Medicaid increased rates by 5.4% for school-based services covered under IEP/IFSP, including psychiatric evaluations, psychotherapy, psychological testing, therapeutic behavior services, and nursing services. This one-time rate increase applies to 12 specific procedure codes and varies by provider type and service.
Action Required
By November 1, 2021: Billing team must update the fee schedule in the billing system with the new rates for all 12 affected procedure codes (90791, 90832, 90834, 90847, 90853, 96130, 96131, 96136, 96137, 96158, 96159, T1000). Rates vary by provider type, so ensure each code is configured with correct rates for psychiatrists, psychologists, LCSW-C, LCPC, Nurse Psychotherapists, LMSW, Therapeutic Behavior Aides, Registered Nurses, and Licensed Practical Nurses as applicable. Update billing software validation rules to reflect new maximum allowable amounts. Notify all providers of the rate changes and ensure claims submitted before November 1 use old rates and claims on or after use new rates. Review any pending claims to ensure correct rate application.