Alabama Medicaid Fee 2026: Complete Provider Rate Guide

Alabama Medicaid updated provider fees for fiscal year 2026 (October 1, 2025 – September 30, 2026).

These changes include higher reimbursement rates for primary care, well-child visits, and therapy services.

For a complete overview of all state Medicaid fee schedules, see our Medicaid fee 2026 national guide.

Quick answers you need:

• Office visit rates: $19.56 to $155.91 for ACHN providers
• Well-child visits: $80 per EPSDT screening (codes 99381-99395 with EP modifier)
• Nursing facility care: $167.02 for initial visits (CPT 99306)
• Pharmacy fee: $10.64 per prescription dispensed
• Income limit: $2,982/month for single nursing home applicants
• Payment schedule: Twice monthly checkwrites, funds arrive second Monday after
• New for 2026: Perinatal mood disorder screenings now covered (age 21+)
• Prior auth removed: Select radiology procedures no longer need approval
• Therapy add-on: 3.27% inflation adjustment, capped at $2.00 per patient day
• QMB income limits: $1,325 individual / $1,783 couple monthly

2026 Primary Care Reimbursement Rates

Alabama Medicaid raised rates for doctors in the Alabama Coordinated Health Network (ACHN). These rates apply to office visits with established patients.

ACHN Office Visit Rates (FY 2026)

Primary Care “Bump” Rates for Hospital & Home Visits

These enhanced rates apply to nursing facilities, hospitals, and home care visits.

To qualify for these enhanced rates, providers must be enrolled in the ACHN network. Check your Alabama Medicaid eligibility 2026 status before billing.

EPSDT Well-Child Visit Fees

Alabama Medicaid pays $80 per well-child screening visit in 2026. This rate took effect July 1, 2025, and continues through the fiscal year.

Reimbursement: $80.00 per visit
Required Modifier: EP (EPSDT modifier)

Covered Age Groups

New Patients:

• 99381 (Under 1 year)
• 99382 (1–4 years)
• 99383 (5–11 years)
• 99384 (12–17 years)
• 99385 (18–20 years)

Established Patients:

• 99391 (Under 1 year)
• 99392 (1–4 years)
• 99393 (5–11 years)
• 99394 (12–17 years)
• 99395 (18–20 years)

Providers must use the EP modifier on claims. Without it, the $80 screening rate won’t apply.

2026 Checkwrite Schedule (Payment Dates)

Alabama Medicaid releases payments twice per month. Funds typically reach provider bank accounts on the second Monday after the checkwrite date.

Mark these dates on your calendar to track incoming payments.

Nursing Facility & Long-Term Care Fees

Alabama Medicaid updated nursing home reimbursement for 2026. Changes include therapy add-ons and new bed value calculations.

Therapy Add-On Rates

From October 1, 2025, to December 31, 2026:

• Inflation adjustment: 3.27% applied to therapy costs
• Services covered: Physical therapy, occupational therapy, speech therapy
• Per diem cap: $2.00 per Medicaid patient day

The state will reconcile actual costs in April 2027 based on June 30, 2026, cost reports.

Nursing Facility Bed Values

New bed asset values for 2026 cost reports:

• Standard value: $25,000 per bed
• Age adjustment: Reduced 1% per year of bed age
• Minimum value: $12,500 per bed (floor)

Application Fees

Institutional providers must pay an application fee unless already enrolled in:

• Medicare
• Another state’s Medicaid program
• CHIP (Children’s Health Insurance Program)

Note: Individual physicians are exempt from application fees.

2026 Income Limits & Eligibility

Income limits determine who can access Alabama Medicaid services. These thresholds affect which providers can bill under certain fee schedules.

Institutional/Nursing Home Medicaid

Single applicants:

• Monthly income: $2,982 or less
• Asset limit: $2,000

Married couples:

• Income limits vary by spousal impoverishment rules
• Community spouse resource allowance applies

Medicare Savings Program (QMB)

Individual:

• Gross monthly income: $1,325 or less

Couple:

• Gross monthly income: $1,783 or less

For detailed eligibility rules, see our guide on Alabama Medicaid income limits 2026.

Dual Eligible Plans (D-SNP)

Some 2026 dual-eligible plans offer enhanced benefits:

• Dental allowance: Up to $1,500 per year
• Transportation: $0 copays for routine medical trips
• Vision and hearing: Additional coverage included

Official Fee Schedule Resources

Use these tools to look up specific CPT codes and current rates:

Alabama Medicaid Fee Schedule Lookup Tool

Access the official 2026 Physician Fee Schedule at medicaid.alabama.gov. You must accept the CPT License Agreement before viewing rates.

Provider Alerts & Updates

Check Alabama Medicaid Alerts for:

• Retroactive rate changes
• Manual revisions
• Policy updates
• Billing reminders

Administrative Code

Review Rule No. 560-X-22-.06 for nursing facility reimbursement methodology and cost report requirements.

Dental Fee Schedule Updates

Alabama Medicaid updated dental fees effective October 1, 2025.

Key changes:

• Space maintainer codes (D1517, D1520) limited to once per tooth per lifetime
• Prior authorization required for some procedures in inpatient settings (POS 21)
• Fee schedule available through the official lookup tool

Always verify prior authorization requirements before performing services.

How to Access Your Fee Schedule

Step 1: Visit medicaid.alabama.gov
Step 2: Navigate to “Provider Resources”
Step 3: Click “Fee Schedule Lookup Tool”
Step 4: Accept the CPT License Agreement
Step 5: Search by CPT code or service type

You can download fee schedules by category or search individual codes.

Frequently Asked Questions

Last Updated: January 20, 2026

Official Sources:

• Alabama Medicaid Agency
• CMS.gov Medicaid Updates