Virginia
highProcedure Fee Files
Run Date and Time
Aug 01, 2026
7m 1s
Run Metrics
Fee Schedule Impacts
Run summary
This run for Virginia DMAS Procedure Fee Files / procedure-fee-files identified 12 changed documents and 0 newly discovered documents. 6 item(s) are high priority.
High Impact (6)
cptmedical2.csv
The document shows a change in reimbursement rates for the procedure 'drainage of nose lesion' (CPT 30000) effective from July 1, 2026. The rate has been updated from 000224.93 to 000226.56 for outpatient services.
Highlights
- •CPT 30000: 'drainage of nose lesion'
- •Rate change from 000224.93 to 000226.56
- •Effective date: 07/01/2026
- •Applies to outpatient services
Reason
The change involves a specific rate update effective soon, impacting reimbursement.
Watch items
audtrail.csv
The document shows significant updates to Medicaid rates, including new procedure codes and rates effective July 1, 2026. Previous codes and rates have been replaced with new entries, indicating a major update to the reimbursement schedule.
Highlights
- •New procedure codes: 97530, 97167, 97166, 97165, 97163, 97162, 97161, 97150, 97140
- •Effective date for new rates: 07/01/2026
- •Old codes (e.g., 99449) have been removed
- •Rates range from $19.51 to $108.73
Reason
The changes involve new procedure codes and rates effective soon, impacting reimbursement.
Watch items
cptmedical2.txt
The document shows a change in reimbursement rates for the procedure 'drainage of nose lesion' (CPT 30000) effective from July 1, 2026. The rate has been updated from 000224.93 to 000226.56 for outpatient services.
Highlights
- •CPT 30000: 'drainage of nose lesion' rate change
- •Old rate: 000224.93
- •New rate: 000226.56
- •Effective date: 07/01/2026
Reason
The change involves a specific rate update effective soon, impacting reimbursement.
Watch items
cptmedical3.txt
The document shows a change in the rate for renal exploration (code 50010) from $603.69 to $555.56, effective from July 1, 2026.
Highlights
- •Rate change for code 50010: $603.69 to $555.56
- •Effective date: July 1, 2026
Reason
The change involves a specific rate adjustment effective soon, impacting reimbursement.
Watch items
cptmedical3.csv
The document shows a change in the rate for the procedure 'renal exploration' (code 50010) from $603.69 to $555.56, effective July 1, 2026.
Highlights
- •Rate change for 'renal exploration' (code 50010).
- •Old rate: $603.69, New rate: $555.56.
- •Effective date: July 1, 2026.
Reason
The change involves a specific rate adjustment effective soon, impacting reimbursement.
Watch items
audtrail.txt
The document shows significant updates to Medicaid rates, including new procedure codes and rates effective July 1, 2026. Previous codes and rates have been replaced with new entries, indicating a major update to the reimbursement schedule.
Highlights
- •New procedure codes added: 97530, 97167, 97166, 97165, 97163, 97162, 97161, 97150, 97140.
- •Effective date for new rates: July 1, 2026.
- •Old codes and rates removed: 99449 with various rates.
- •New maximum rates range from $19.51 to $108.73.
- •Changes affect outpatient services in region 0003.
Reason
The changes involve new procedure codes and rates effective soon, impacting reimbursement.
Watch items
Medium Impact (6)
cptmedical1.csv
The document contains updates to Medicaid rate schedules with effective dates starting from April 1, 2026. It includes entries for medical analyses with codes such as 0614u, 0615u, and 0616u, but no specific rate changes are detailed.
Highlights
- •Effective date: 04/01/2026
- •Codes: 0614u, 0615u, 0616u
- •No specific rate changes noted
- •Entries for medical analyses
Reason
The document is current but lacks specific rate changes, indicating limited immediate impact.
Watch items
hcpcmedical.txt
The document shows changes in reimbursement rates for the code A9576, 'inj prohance multipack,' with a new rate of 000001.36 effective from 07/01/2026 to 12/31/9999, replacing the previous rate of 000001.39 effective from 04/01/2026 to 06/30/2026.
Highlights
- •Code A9576 rate changed from 000001.39 to 000001.36.
- •New effective date for A9576 is 07/01/2026.
- •Previous rate for A9576 was effective from 04/01/2026 to 06/30/2026.
Reason
The changes are not effective immediately but are scheduled for future implementation.
Watch items
cptmedical1.txt
The document contains updates to Medicaid rate schedules with effective dates starting April 1, 2026. It includes entries for medical analyses with codes such as 0614u, 0615u, and 0616u, but no specific rate changes are detailed.
Highlights
- •Effective date: 04/01/2026
- •Codes: 0614u, 0615u, 0616u
- •No specific rate changes noted
- •Entries for medical analyses
Reason
The document is current but lacks specific rate changes, indicating limited immediate impact.
Watch items
cptmedical4.txt
The document shows a change in the reimbursement rate for the CPT code 80050 (general health panel) from $8.36 to $5.50, effective July 1, 2026.
Highlights
- •CPT code 80050 rate changed from $8.36 to $5.50.
- •Effective date for new rate: July 1, 2026.
Reason
The rate change is significant but not effective immediately, requiring future attention.
Watch items
cptmedical4.csv
The document shows a change in the reimbursement rate for the CPT code 80050 (general health panel) from $8.36 to $5.50, effective July 1, 2026.
Highlights
- •CPT code 80050 rate changed from $8.36 to $5.50.
- •Effective date for new rate: July 1, 2026.
Reason
The rate change is significant but not effective immediately, requiring future attention.
Watch items
hcpcmedical.csv
The document shows changes in reimbursement rates for the code A9576, 'inj prohance multipack,' effective from July 1, 2026, with a rate of 000001.36. Previously, the rate was set to change on April 1, 2026, at 000001.39.
Highlights
- •Code A9576 'inj prohance multipack' rate change.
- •New rate: 000001.36 effective 07/01/2026.
- •Old rate: 000001.39 effective 04/01/2026.
Reason
The changes are not effective immediately but are scheduled for future dates, indicating a need for review but not urgent action.
Watch items
Low Impact (0)
No documents in this severity group.