MedicaidCoverageHigh impact
Medicaid Fee-for-Service Payment of Medically Necessary Ancillaries on Administrative Days
Maryland Medicaid·MD · Cardiology, Critical Care, Nephrology +2 more·Hospital
Effective date
Jan 1, 2026
We identified it
Jul 11, 2026
Summary
Maryland Medicaid FFS updated its policy on billing ancillary services (labs, imaging, dialysis, respiratory services, EKG) during Administrative Days. Medical/surgical supplies are no longer covered on Administrative Days as costs are incorporated into the base rate. Hospitals must document medical necessity, complete the MDH 1288 form with placement activities, and request retrospective UCA review. Revenue codes for BMP and CMP have been updated to 0301.
Action Required
By March 31, 2026: Hospital billing teams must (1) Remove medical/surgical supplies from all Administrative Day ancillary billing requests and verify they are no longer submitted with Admin Day claims; (2) Update billing system revenue code mappings to use 0301 for both BMP (CPT 80048) and CMP (CPT 80053) ancillaries on Administrative Days; (3) Train billing staff on the complete list of 13 covered ancillaries (labs, radiology, cardiology, renal, respiratory services) and ensure only these services are billed on Admin Days; (4) Implement workflow requiring completion of MDH 1288 form with documented placement activities (minimum 2 per Admin Day) before submitting retrospective review to UCA; (5) Update internal policies to reflect this change supersedes PT 11-25. Billing team must verify all Administrative Day claims include only eligible ancillaries or they will be denied by UCA. Contact mdh.acutehospitalpolicy@maryland.gov for clarification.