MedicaidReimbursementHigh impact
Resource Based Relative Value Scale (RBRVS) Rates Effective July 1, 2026
Virginia Medicaid - DMAS·VA·Provider Memo
Effective date
Jul 1, 2026
We identified it
Sep 11, 2026
Summary
Virginia Medicaid is updating physician reimbursement rates effective July 1, 2026, based on the CMS Physician Fee Schedule (CMS-1807-F). All providers billing Virginia Medicaid must use the new RBRVS rates found on the DMAS website. Managed Care Organizations (MCOs) will implement rate changes within 30-60 days and automatically reprocess claims paid under old rates.
Action Required
By July 1, 2026: Billing team must access updated procedure code rates from the DMAS website at https://dmas.virginia.gov/for-providers/rates-and-rate-setting/ in the Procedure Fee Files & CPT Codes section and load new rates into billing software for all Virginia Medicaid claims. Providers may bill MCOs immediately under old rates or delay billing until FY2027 rates are updated by MCOs (which may take 30-60 days). Before July 1, 2026: Verify provider enrollment information is current in the Provider Services Solution (PRSS) portal to ensure claims are not rejected. Failure to update rates in billing software may result in incorrect claim payments and potential underbilling. Contact the provider helpline at 800-552-8627 with rate-related questions. Monitor the DMAS provider portal regularly for MCO implementation timelines and automatic claim reprocessing updates.