Professional Services Rate Increases - Effective July 1, 2021
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The purpose of this bulletin is to inform providers and Medicaid MCOs of rate increases mandated by the 2021 Appropriation Act. All rate changes are effective July 1, 2021.
Psychiatric Services Rate Increase
In accordance with Item 313.EEEE of the 2021 Appropriation Act, DMAS increased practitioner rates for psychiatric services to reflect 110 percent of Medicare rates. DMAS first adjusted rates to reflect changes in relative value units (RVUs) in a budget neutral exercise as described in regulations and then increased rates by 14.7 percent. The actual increase by procedure code varies because of the adjustment for changes in RVUs. This increase affects all Fee for Service and MCO enrolled providers of these services.
Psychiatric Services rates may be found on the DMAS web site at: https://www.dmas.virginia.gov/for-providers/general-information/procedure-fee-files-cpt-codes/.
Anesthesia Rate Increase
In accordance with Item 313.UUUU of the 2021 Appropriation Act, DMAS increased practitioner rates for anesthesia to reflect 70 percent of the 2019 Medicare rates. DMAS increased the Virginia Medicaid anesthesia conversion factor to $15.47. The flat rate for procedure code 01967 for labor epidurals increased to $237.16.
Anesthesia rate calculation information may be found on the DMAS web site at: https://www.dmas.virginia.gov/for-providers/general-information/rate-setting/ under Physician.
For questions regarding practitioner rates, please contact Taryn Gulkewicz at (804) 786-0037 or email Taryn.Gulkewicz@dmas.virginia.gov.
The purpose of this bulletin is to inform providers and Medicaid MCOs of rate increases mandated by the 2021 Appropriation Act. All rate changes are effective July 1, 2021.
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PROVIDER CONTACT INFORMATION & RESOURCES |
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Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
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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 |
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KEPRO Service authorization information for fee-for-service members.
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Provider Appeals DMAS is launching an appeal portal in late May 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. |
https://www.dmas.virginia.gov/#/appealsresources
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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. |
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Medallion 4.0 |
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CCC Plus |
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PACE |
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Magellan Behavioral Health Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members. |
www.MagellanHealth.com/Provider For credentialing and behavioral health service information, visit: www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or Call: 1-800-424-4046 |
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Provider HELPLINE Monday–Friday 8:00 a.m.-5:00 p.m. For provider use only, have Medicaid Provider ID Number available. |
1-804-786-6273 1-800-552-8627 |
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Aetna Better Health of Virginia |
www.aetnabetterhealth.com/Virginia 1-800-279-1878 |
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Anthem HealthKeepers Plus |
1-800-901-0020 |
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Magellan Complete Care of Virginia |
1-800-424-4518 (TTY 711) or 1-800-643-2273 |
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Optima Family Care |
1-800-881-2166 www.optimahealth.com/medicaid |
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United Healthcare |
and www.myuhc.com/communityplan 1-844-752-9434, TTY 711 |
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Virginia Premier |
1-800-727-7536 (TTY: 711), www.virginiapremier.com |