Virginia
highProcedure Fee Files
Run Date and Time
Apr 01, 2026
12m 57s
Run Metrics
Fee Schedule Impacts
Run summary
This run for Virginia DMAS Procedure Fee Files / procedure-fee-files identified 10 changed documents and 0 newly discovered documents. 3 item(s) are high priority.
High Impact (3)
audtrail.txt
The document shows significant changes in procedure codes and rates, with new codes replacing old ones and updated rates effective from 2025 to 2026. These changes could impact reimbursement policies.
Highlights
- •Old codes (e.g., a4297, a4296) replaced with new code q5130.
- •New rates for q5130 range from $127.22 to $183.51.
- •Effective dates for new rates span from 01/01/2025 to 01/01/2026.
- •Old rates were set to start on 01/01/2026.
Reason
The changes involve new procedure codes and rates effective soon, impacting reimbursement.
Watch items
audtrail.csv
The document shows significant changes in procedure codes and rates, with new codes replacing old ones and updated rates effective from 2025 to 2026. These changes could impact reimbursement policies.
Highlights
- •Old codes (e.g., a4297, a4296) replaced with new code q5130.
- •New rates for q5130 range from $127.22 to $183.51.
- •Effective dates for new rates span from 01/01/2025 to 01/01/2026.
- •Old rates were set to start on 01/01/2026, now replaced.
Reason
The changes involve new procedure codes and rates effective soon, impacting reimbursement.
Watch items
cptmedical4.txt
The document includes updates to CPT codes 81515 and 81517 with effective dates starting January 1, 2025, and January 1, 2024, respectively. These changes are set to last until December 31, 9999, indicating long-term applicability.
Highlights
- •CPT code 81515 effective from 01/01/2025
- •CPT code 81517 effective from 01/01/2024
- •Both codes have an end date of 12/31/9999
Reason
The updates involve new effective dates for specific CPT codes, impacting reimbursement policies soon.
Watch items
Medium Impact (3)
cptmedical4.csv
The document includes updates to Medicaid rates with effective dates for certain CPT codes, notably 81515 and 81517, with changes effective from 2024 and 2025.
Highlights
- •CPT code 81515 effective from 01/01/2025.
- •CPT code 81517 effective from 01/01/2024.
- •Rates for these codes are set to 000231.43 and 000155.05 respectively.
- •Effective dates extend to 12/31/9999.
Reason
The changes involve future effective dates and specific CPT codes, but do not indicate immediate urgency.
Watch items
cptmedical3.csv
The document update includes a new entry for CPT code 76014, effective from January 1, 2025, with a rate of 000009.38 for both inpatient and outpatient settings. This change is set to last until December 31, 9999.
Highlights
- •New CPT code 76014 added.
- •Effective date: 01/01/2025.
- •Rate: 000009.38 for inpatient and outpatient.
- •End date: 12/31/9999.
Reason
The changes are relevant but not immediately urgent as they are effective in 2025.
Watch items
cptmedical3.txt
The document update includes a new entry for CPT code 76014, effective from January 1, 2025, with a rate of 000009.38 for both inpatient and outpatient settings. This change is set to last until December 31, 9999.
Highlights
- •New CPT code 76014 added.
- •Effective date: 01/01/2025.
- •Rate: 000009.38 for inpatient and outpatient.
- •End date: 12/31/9999.
Reason
The changes are relevant but not immediately effective, with a future start date in 2025.
Watch items
Low Impact (4)
cptmedical1.csv
The document contains historical data with no clear updates to current Medicaid rates or policies. The excerpts primarily reference old effective dates and unchanged rate values.
Highlights
- •No new effective dates identified.
- •No changes in reimbursement rates detected.
- •References to historical CPT codes like '0026u' and '0027t'.
- •No new CPT codes or billing instructions added.
Reason
The document appears to be historical with no immediate impact on current Medicaid policies or rates.
hcpcmedical.txt
The document shows changes related to CPT codes G0491, G0492, and G0493, with no apparent rate changes or new effective dates. The effective dates remain from 2017 to 9999, indicating no immediate updates.
Highlights
- •CPT codes G0491, G0492, G0493 mentioned.
- •Effective dates remain 01/01/2017 to 12/31/9999.
- •No rate changes detected.
- •No new effective dates introduced.
Reason
No immediate reimbursement or policy changes detected.
cptmedical1.txt
The document contains historical data with no clear updates to current Medicaid rates or policies. The excerpts primarily show unchanged entries with effective dates far in the past, such as 2007-2008.
Highlights
- •No new rate changes identified.
- •Entries with effective dates from 2007-2008 remain unchanged.
- •No new CPT/HCPCS codes added or removed.
- •No effective date updates for current policies.
Reason
The document appears to be historical with no immediate impact on current Medicaid policies or rates.
hcpcmedical.csv
The document shows changes related to CPT codes G0491, G0492, and G0493, but no specific rate or policy changes are evident. The effective dates remain unchanged, indicating no immediate impact.
Highlights
- •CPT codes G0491, G0492, G0493 mentioned.
- •No rate changes detected.
- •Effective dates remain 01/01/2017 to 12/31/9999.
- •No new billing instructions or coverage limitations.
Reason
No immediate reimbursement or policy changes detected.