MedicaidReimbursementHigh impact
Private Duty and Skilled Nursing Update Effective July 1, 2026
Virginia Medicaid - DMAS·VA · Geriatrics, Palliative Care·Specialty Services
Effective date
Jul 1, 2026
We identified it
Sep 11, 2026
Summary
Effective July 1, 2026, Virginia Medicaid updates reimbursement rates for Skilled Nursing (S9123, S9124) and Private Duty Nursing (T1002, T1003) codes per the 2026 Appropriation Act. Managed Care Organizations (MCOs) must align their rates with the revised FFS rates and will automatically reprocess claims within 30 days of system updates; providers may bill immediately under old rates or delay billing until MCO systems are updated.
Action Required
By June 30, 2026: Billing team must verify updated rates for S9123, S9124, T1002, and T1003 on the DMAS website (https://dmas.virginia.gov/for-providers/rates-and-rate-setting/) and update all billing software with new reimbursement amounts. Ensure Provider Services Solution (PRSS) enrollment information, contact details, and license information are current for all service locations to prevent claim denials—MCOs and DMAS cannot pay claims to providers not enrolled in PRSS. Beginning July 1, 2026: Bill MCOs using either old rates (if preferred) or new rates once MCO systems are updated (expected 30-60 days after rates post). Document billing rate used for each claim. Anticipate automatic claim reprocessing by MCOs approximately 30 days after their system updates are complete; review remittance advice for adjustments. If rate discrepancies appear on payment, file an appeal with DMAS Appeals Division within 30 days via the appeals portal (https://www.dmas.virginia.gov/appeals/), mail, email, or fax (appeals@dmas.virginia.gov or 804-452-5454). Contact provider helpline at 800-552-8627 with rate questions.