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Ambulatory Surgical Center Reimbursement - Effective July 1, 2022

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Effective Date:

Ambulatory Surgical Centers and Medicaid Managed Care Organizations (MCOs)
Cheryl J. Roberts, Acting Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to inform Ambulatory Surgical Center (ASC) providers about reimbursement updates for state fiscal year 2023 (SFY23). 

As stated in the June 28, 2022 bulletin on “Implementation of new rates from 2022 State Budget Appropriations,” DMAS is diligently working on the implementation of new rates set forth in the 2023 Appropriation Act approved by Governor Youngkin June 22, 2022. The new fiscal year 2023 rates may not be posted online before July 1, 2022. At this time providers have the option to bill immediately under old rates, and later adjust their claims or delay billing until rates are updated. Additionally, Managed Care Organizations (MCOs) are working to update their rate systems, but providers will need to work with their MCO partners to determine billing procedures.

ASC Rebasing

In accordance with 12VAC30-80-35 and the Medicaid Memorandum dated March 4, 2010, DMAS established new ASC Enhanced Ambulatory Patient Group (EAPG) weights and an updated base rate effective July 1, 2022. DMAS implemented the EAPG grouper version 3.16 grouper and will use the national weights developed by 3M. The updated statewide base rate of $299.38 is calculated to ensure budget neutrality of total ASC expenditures in accordance with 12VAC30-80-35. The new EAPG weights and base rate will be effective for claims with dates of service on or after July 1, 2022.

The EAPG ASC weights and the statewide base rate are available on the DMAS web site at Select Providers, Rates and Rate Setting; scroll down to the Ambulatory Surgical Centers section. To contact 3M for more information about EAPG software, please call 1-800-367-2447 or use the following link:



Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

Medicall (Audio Response System)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

1-800-884-9730 or 1-800-772-9996


Service authorization information for fee-for-service members.


Provider Appeals

DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal.

Managed Care Programs

Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE).  In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider.  The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals.

Medallion 4.0

CCC Plus


Magellan Behavioral Health

Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members.

For credentialing and behavioral health service information, visit:, email:,or

Call: 1-800-424-4046


Monday–Friday 8:00 a.m.-5:00 p.m.  For provider use only, have Medicaid Provider ID Number available.



Aetna Better Health of Virginia


Anthem HealthKeepers Plus


Molina Complete Care


1-800-424-4524 (CCC+)

1-800-424-4518 (M4)

Optima Family Care


United Healthcare


1-844-752-9434, TTY 711

Virginia Premier

1-800-727-7536 (TTY: 711),