Outpatient Rehabilitation Rates Effective July 1, 2026

REQUIREMENTS: Before July 1, 2026: Billing team must verify that outpatient rehabilitation service rates have been updated in the practice's billing system and fee schedules. Access updated rates on the DMAS website at https://www.dmas.virginia.gov/for-providers/rates-and-rate-setting/ in the Rehab Agencies section under the Institutional heading. Immediately: Verify that the practice's enrollment, contact information, and license information are current in the Provider Services Solution (PRSS) portal for all service locations. Non-enrolled or outdated provider records will result in claim payment denials from both fee-for-service and MCO plans. Before July 1, 2026: Billing team should monitor PRSS portal and DMAS website for MCO-specific rate implementation timelines. MCOs may require up to 30-60 days to update their systems; the practice may bill MCOs under old rates immediately or delay billing until FY2027 rates are updated—establish internal protocol for which approach the practice will use. By August 30, 2026 (30 days after effective date): Review initial claim payments to verify rates reflect the July 1, 2026 update. If payment errors are identified, file an informal appeal with DMAS Appeals Division through the portal at https://www.dmas.virginia.gov/appeals/ or via mail to Appeals Division, DMAS, 600 E. Broad Street, Richmond, VA 23219; email appeals@dmas.virginia.gov; or fax (804) 452-5454. Appeals must be filed within 30 days of payment being published. Ongoing: Ensure staff monitor the DMAS provider portal periodically for updated contact and enrollment status. Maintain awareness that MCOs will automatically reprocess claims within approximately 30 days after they complete system updates; no additional billing action is required for reprocessing.