Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against official Medicaid.gov and Maryland Department of Health guidelines | Last Updated: March 2026
The Maryland Medicaid fee schedule for 2026 lists how much the state pays providers for covered services.
The Maryland Department of Health (MDH) published updated rate lists effective January 1, 2026. Some files were revised as recently as February 2026.
This guide covers every active 2026 fee schedule, verified reimbursement rates, eligibility income limits, and key federal policy changes that affect Maryland providers and enrollees.
Quick Summary
- The 2026 Professional Services Fee Schedule took effect January 1, 2026, and was last updated February 17, 2026
- DME fee schedules now follow quarterly update cycles aligned with Medicare
- Home health rates vary by county — Baltimore City skilled nursing pays $159.00 per visit
- New income limits became effective February 1, 2026 — a single adult qualifies at $1,835/month
- Federal transparency rules require published fee schedules by July 1, 2026
- Use our Medicaid eligibility calculator for 2026 to check if you or your family qualifies
What Is a Medicaid Fee Schedule?
A Medicaid fee schedule is a list of payment rates. It tells providers how much Medicaid will pay for each covered service.
Every service has a billing code. The fee schedule matches each code to a dollar amount.
Maryland Medicaid uses fee-for-service (FFS) rates for about 15% of enrollees. The other 85% get care through HealthChoice, the state’s managed care program.
Even managed care organizations (MCOs) often base their rates on the state fee schedule.
Why Fee Schedules Matter
Fee schedules affect both providers and patients. Providers use them to know what they will be paid. Patients benefit because fair rates help keep doctors in the Medicaid network.
When rates are too low, providers may stop accepting Medicaid. That limits access to care.
Maryland law requires the state to compare its Medicaid rates with Medicare rates each year. This helps ensure Maryland stays competitive with neighboring states.
Maryland Medicaid Fee Schedules for 2026: Active Rate Lists
The Maryland Department of Health has published several active fee schedules for 2026.
Each covers a different type of service. Below are the verified schedules, their effective dates, and key changes.
You can compare these with the national Medicaid fee schedule for 2026 to see how Maryland rates stack up.
Professional Services Fee Schedule
This is the main fee schedule for Maryland Medicaid. It covers standard physician services, evaluation and management (E&M) visits, and procedural codes (CPT codes).
- Status: Active
- Effective Date: January 1, 2026
- Last Verified Update: February 17, 2026
- What It Covers: General medical services, office visits, surgical procedures, and diagnostic services
Maryland Medicaid E&M rates are close to 100% of Medicare rates. This is higher than many other states. It helps Maryland attract and keep providers in the Medicaid network.
DME/DMS Fee Schedule (Durable Medical Equipment & Supplies)
This schedule covers wheelchairs, oxygen equipment, catheters, and other medical supplies.
- Status: Active
- Effective Date: January 1, 2026
- Update Cycle: Quarterly — January 1, April 1, July 1, and October 1
- Key 2026 Change: Three new HCPCS codes were added. Two existing codes were modified. These changes apply to hydrophilic intermittent urinary catheters.
The quarterly updates now align with Medicare cycles. This makes it easier for providers who bill both programs.
Home Health Services Fee Schedule
Home health rates in Maryland depend on the county where the agency’s home office is located. Rates vary across the state.
- Status: Active
- Effective Date: January 1, 2026
Sample Verified Rates (Per Visit):
| Location | Skilled Nursing | Home Health Aide | Physical Therapy |
|---|---|---|---|
| Baltimore City | $159.00 | $77.13 | $171.92 |
| Washington, D.C. (serving MD) | $174.54 | $84.69 | $188.76 |
Agencies in the D.C. metro area receive higher rates. This reflects the higher cost of living in that region.
Medical Laboratory Fee Schedule
MDH also published the 2026 Medical Laboratory Fee Schedule. It is available in both PDF and Excel formats on the MDH provider information page.
Lab services have their own set of CPT codes and reimbursement rates.
Maryland Medicaid Income Limits for 2026
New income limits took effect on February 1, 2026. These limits decide who qualifies for Maryland Medicaid.
Most applicants use Modified Adjusted Gross Income (MAGI) rules. MAGI looks at taxable income. It does not count savings or property.
Check the full list of Medicaid income limits by state for 2026 to see how Maryland compares to other states.
| Household Size | Monthly Limit (Adults) | Monthly Limit (Children) |
|---|---|---|
| 1 Person | $1,835 | $4,283 |
| 2 People | $2,490 | $5,809 |
| 3 People | $3,142 | $7,332 |
Long-Term Care Limits
Seniors and people with disabilities have different rules. These are Non-MAGI programs. They include asset tests.
- Single Applicant Asset Limit: $2,500
- Community Spouse Resource Allowance (CSRA): A non-applicant spouse can keep 50% of assets, up to $162,660
This protects the spouse who is not applying. They can keep enough money to live on while their partner gets Medicaid long-term care.
What Does Maryland Medicaid Cover?
Maryland Medicaid covers a wide range of health services. The fee schedule lists rates for each of these covered services.
Core Benefits
Maryland Medicaid covers doctor visits, hospital stays, prescription drugs, lab tests, X-rays, and mental health services.
It also covers preventive care, maternity care, and pediatric services for children through the Maryland Children’s Health Program (MCHP).
Additional Services
Maryland also covers home health care, durable medical equipment, nursing facility care, and transportation to medical appointments. Dental care is covered for children. Adult dental benefits are more limited but still available for certain services.
Behavioral Health
Behavioral health services in Maryland are managed separately. Carelon Behavioral Health of Maryland (formerly Beacon Health Options) administers the Public Behavioral Health System (PBHS).
Providers should check the Carelon portal for behavioral health-specific fee schedules and billing codes.
A standalone 2026 behavioral health fee schedule has not been released as a separate public file. Providers should refer to the Professional Services schedule or the Carelon Maryland portal for specific codes.
Federal and Policy Updates Affecting Maryland in 2026
Several federal changes affect Maryland Medicaid fee schedules and coverage in 2026. Both providers and enrollees should be aware of these changes.
Medicare Alignment
The Centers for Medicare & Medicaid Services (CMS) finalized the CY 2026 Physician Fee Schedule (PFS) effective January 1, 2026. Maryland Medicaid often aligns its code updates with these federal definitions. The catheter HCPCS code changes mentioned above are one example.
Telehealth Updates
Maryland continues to refine telehealth policies in 2026. Federal rules now permanently allow the G2211 add-on code. This code applies to complex home visits. It may affect how Maryland providers bill for home-bound patients.
Fee Schedule Transparency
Starting July 1, 2026, new federal rules require states to publish transparent and accessible fee-for-service rate schedules. Maryland must comply with these stricter mandates. This means more fee schedule data will be available to the public.
Potential Federal Funding Changes
New Medicaid requirements under recent federal legislation could reduce Maryland’s federal Medicaid funding. Maryland Medicaid spending was about $15.4 billion in FY2026.
About 96% of that went directly to care and services. Changes to immigrant eligibility take effect October 1, 2026, and work requirements for ACA expansion adults begin January 1, 2027.
How to Access the Official Maryland Medicaid Fee Schedules
Getting the right fee schedule is important for accurate billing. Here is how to find each document.
Step 1: Visit the MDH Provider Information Page
Go to the Maryland Department of Health Provider Information page. This is the official source for all fee schedules.
Step 2: Download the Right Schedule
Choose the fee schedule that matches your service type. Options include Professional Services, DME/DMS, Home Health, and Medical Laboratory. Files are available in PDF and Excel formats.
Step 3: Check for Updates
Fee schedules can change during the year. The Professional Services schedule was revised on February 17, 2026. DME schedules update quarterly. Bookmark the page and check back often.
Step 4: Contact MDH with Questions
If you have billing questions, contact the Maryland Medicaid provider line. You will need your Provider ID number, NPI, or the recipient’s Medicaid ID.
What Happens After You Apply for Maryland Medicaid?
If you are not a provider but a person seeking coverage, here is what to expect after applying.
The Application Process
You apply through Maryland Health Connection. The state reviews your application. They may ask for more documents. Send these quickly. You will get a decision letter in the mail.
Timeline
Most decisions take up to 45 days. Pregnant women get faster decisions. If approved, you pick a health plan (MCO). Then you start using your benefits.
Your Medicaid Card
Once approved, you receive a Medicaid card. This card lets you see doctors, fill prescriptions, and access all covered services at the rates listed in the fee schedule.
Dental and Behavioral Health Fee Schedules: What to Know
Many people ask about standalone dental and behavioral health fee schedules for 2026. Here is the current status.
Dental Services
Dental services are included in the Professional Services fee schedule. There is no separate public document titled “Maryland Medicaid Dental Fee Schedule 2026.”
Maryland ranked fourth among its neighboring states for dental reimbursement rates — behind Delaware, Washington D.C., and Virginia.
Behavioral Health Services
Behavioral health is administered through the Public Behavioral Health System. Carelon Behavioral Health of Maryland manages these services. Providers should visit the Carelon Maryland portal for specific fee schedules and billing codes.
FAQ
Q: What is the Maryland Medicaid fee schedule for 2026?
A: The Maryland Medicaid fee schedule for 2026 is a list of payment rates the state uses to reimburse providers. It covers professional services, DME, home health, and lab services. The main schedule took effect January 1, 2026. MDH last updated it on February 17, 2026. Providers can download it from the MDH provider information page.
Q: How much does Maryland Medicaid pay for a skilled nursing home visit in 2026?
A: Maryland Medicaid pays different rates by county for home health services. In Baltimore City, a skilled nursing visit pays $159.00 per visit in 2026. Agencies based in the D.C. area receive $174.54 per visit. Rates are higher in areas with a higher cost of living.
Q: Does Maryland Medicaid cover dental care in 2026?
A: Yes, Maryland Medicaid covers dental care. Children have full dental coverage through the Maryland Children’s Health Program (MCHP). Adult dental benefits are more limited. Dental rates are listed in the Professional Services fee schedule. There is no separate dental fee schedule document for 2026.
Q: What are the Maryland Medicaid income limits for 2026?
A: For 2026, a single adult in Maryland can earn up to $1,835 per month and qualify for Medicaid. A child in a one-person household qualifies at up to $4,283 monthly. Limits increase with household size. These new limits became effective February 1, 2026. Most applicants use MAGI income rules.
Q: How often does Maryland update its Medicaid fee schedule?
A: It depends on the service type. The Professional Services fee schedule is updated as needed — it was last revised February 17, 2026. The DME fee schedule now updates quarterly on January 1, April 1, July 1, and October 1 to align with Medicare. Providers should check the MDH website regularly.
Q: Where can I download the official Maryland Medicaid fee schedule?
A: You can download all Maryland Medicaid fee schedules from the Maryland Department of Health provider information page at health.maryland.gov. Look for the “Provider Information” section. Files are available in both PDF and Excel formats. Always use the most recent version.
Sources & Disclaimer
Sources:
- Maryland Department of Health — Provider Information & Fee Schedules
- Medicaid.gov — Official Federal Medicaid Resources
- Healthcare.gov — Medicaid & CHIP Overview
- CMS Fee Schedules — General Information
Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. For official eligibility, contact your state Medicaid office or visit Medicaid.gov.
