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[Virginia] PRTF carve-out services and billing codes
Effective date
Nov 1, 2026
Identified
Oct 16, 2026
Summary
HealthKeepers' Virginia Medicaid notice (dated October 15, 2026) lists which psychiatric residential treatment facility (PRTF) services are paid through fee-for-service Medicaid instead of the managed care plan, and which stay with the plan. The notice header says it is effective November 1, 2026, which has already passed, while its text describes the carve-out as effective November 1, 2025, so confirm the current routing.
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What to do
Action · 6 steps
01Effective 11/01/2026 per the notice header (already passed): Billing team: review billing workflows and system configuration so PRTF claims go to the correct payer.
02Bill the carved-out services through fee-for-service: main PRTF facility services, EPSDT residential services, facility per diem revenue codes 1001 (PRTF) and 0961 (EPSDT), and CPT-coded services furnished by facility employees (counseling, physician oversight, medication management and lab), using the listed codes such as G0177, H2027, H0024, H0025, S9445 and T1012 for the related services.
03Submit claims for services that stay with the member's MCO (hospital, physician, outpatient and inpatient care, pre-admission and post-discharge behavioral health, ARTS community care and home visits, and pharmacy services that meet the MCO's ordering, referring and prescribing requirements) to the MCO.
04Share the notice with billing, clinical, utilization management and administrative staff involved in PRTF services.
05The source lists 96130-96203 as one range, so confirm the endpoint codes with Provider Services at 800-901-0020.
06Sign up for biller alerts through the link in the notice.
Codes mentioned
G0177H2027H0024H0025S9445T10129922199222992239923199232992338030580306803079078590791907929613096203994069940799408994099083290833908349083690837908389083990840908459084690847908539086390865908679086890870908859715197154971559715697157
Original notice
[Virginia] PRTF carve-out services and billing codes
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →Related policy hubs
Anthem BCBS policiesVA policy changesPsychiatryPediatricsPharmacyCode G0177Code H2027Code H0024Code H0025Code S9445Code T1012Code 99221Code 99222Code 99223Code 99231Code 99232Code 99233Code 80305Code 80306Code 80307Code 90785Code 90791Code 90792Code 96130Code 96203Code 99406Code 99407Code 99408Code 99409Code 90832Code 90833Code 90834Code 90836Code 90837Code 90838Code 90839Code 90840Code 90845Code 90846Code 90847Code 90853Code 90863Code 90865Code 90867Code 90868Code 90870Code 90885Code 97151Code 97154Code 97155Code 97156Code 97157