MedicaidReimbursementHigh impact
Clinical Laboratory Services Procedure Code Rates Effective July 1, 2026
Virginia Medicaid - DMAS·VA·Claims & Billing
Effective date
Jul 1, 2026
We identified it
Sep 11, 2026
Summary
Virginia Medicaid (DMAS) is updating Clinical Laboratory Services procedure code rates effective July 1, 2026. Providers must access the new rates on the DMAS website and prepare for system updates from Managed Care Organizations (MCOs), which may take 30-60 days to implement. Claims paid under old rates will be automatically reprocessed once systems are updated.
Action Required
By July 1, 2026: Billing team must access updated Clinical Laboratory Services procedure code rates at https://dmas.virginia.gov/for-providers/rates-and-rate-setting/ in the Procedure Fee Files & CPT Codes section. Update billing system with new rates for all laboratory procedures. For MCO claims: providers may bill immediately under old rates OR delay billing until FY2027 rates are updated by MCOs (which may take 30-60 days from 7/1/2026). Ensure provider enrollment information, contact details, and license information are current in the PRSS (Provider Services Solution) portal to avoid claim denials. Monitor the DMAS provider portal regularly for system updates. Note: MCOs will automatically reprocess claims paid under old rates approximately 30 days after their system updates; DMAS will automatically reprocess fee-for-service claims once updated. Contact provider helpline at 800-552-8627 with questions about specific rates.