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The purpose of this bulletin is to address the collection of application fees for pharmacies enrolled with the Department of Medical Assistance Services (DMAS).

Pursuant to the 21st Century Cures Act, all providers are required to enroll and periodically revalidate their enrollment directly with DMAS through its Provider Services Solution (PRSS) portal. These requirements, as outlined in Title 42 CFR § 455.460, include the collection of mandatory application fees for certain institutional provider types.   

Application Fees

CMS provided clarification to DMAS that a pharmacy enrolled with Provider Class Type 60-Pharmacy and/or Provider Class Type 61-Pharmacy-Long Term Care is classified as an institutional provider type.  As such, they are subject to application fee requirements that must be collected from each service location at initial enrollment, re-enrollment, and revalidation. The application fee does not apply to Provider Class Type 268-Pharmacist.

DMAS will not retroactively collect application fees from enrolled pharmacies; however, effective August 1, 2025, these mandatory fees will be collected with all applications for new enrollments, reenrollments, and revalidations. 

CMS sets the application fee annually. The fee may vary from year to year based on the consumer price index for all urban consumers (CPI-U). The application fee for calendar year 2025 is $730. Providers may be exempt from paying the application fee to Virginia Medicaid if they have already paid another state Medicaid program or Medicare.  The provider may also be granted a waiver if there is a documented hardship approved by Medicare. Virginia Medicaid will require proof of previous payment or financial hardship before the application or renewal can be processed. Both the hardship waiver and the exemption requests are handled as part of the enrollment process.

Where to Get More Information

Information regarding the federal application fee can be found at Federal Register :: Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount for Calendar Year 2025  Additional information and resources related to DMAS provider enrollment and revalidations is available on the DMAS Medicaid Enterprise System (MES) provider page.