MedicaidReimbursementHigh impact
Physician Administered Drug Procedure Code Rates Effective July 1, 2026
Virginia Medicaid - DMAS·VA·Pharmacy
Effective date
Jul 1, 2026
We identified it
Sep 11, 2026
Summary
Virginia Medicaid is updating reimbursement rates for Physician Administered Drug procedure codes effective July 1, 2026. Rates are posted on the DMAS website and MCOs must increase reimbursement to match revised FFS rates. Providers should verify updated rates in their billing systems and be prepared for claim reprocessing once MCO systems are updated (30-60 days after posting).
Action Required
By August 13, 2026: Billing team must access the DMAS website (https://dmas.virginia.gov/for-providers/rates-and-rate-setting/) and download updated Procedure Fee Files & CPT Codes for Physician Administered Drug codes effective July 1, 2026. Update billing software and fee schedules to reflect new rates. Monitor MCO communications for specific FY2027 rate implementation timelines (MCOs may need 30-60 days to update systems). Beginning August 13, 2026: Providers may bill MCOs immediately at old rates or delay billing until FY2027 rates are active in MCO systems. Within 30 days of MCO system updates: Expect automatic claim reprocessing for claims paid at old rates. For FFS claims: DMAS will automatically reprocess once their system reflects new rates. All providers must ensure enrollment, contact information, and license information are current in the Provider Services Solution (PRSS) portal at https://www.dmas.virginia.gov/for-providers/provider-enrollment-revalidation/ to avoid payment holds. If rate discrepancies are identified, file appeals with DMAS Appeals Division (appeals@dmas.virginia.gov, fax 804-452-5454, or mail to 600 E. Broad Street, Richmond, VA 23219) within 30 days of rate publication. Contact provider helpline at 800-552-8627 with questions about rates.