Mississippi Medicaid Fee Schedule 2026: Rates, Codes & How to Use Them

Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against Mississippi Division of Medicaid (DOM) and CMS official publications | Last Updated: March 2026

The Mississippi Medicaid fee schedule for 2026 sets the official reimbursement rates providers receive for covered services.

The Mississippi Division of Medicaid (DOM) has confirmed fee schedules for dental, behavioral health, rural health clinics, ambulatory surgical centers, and more — all effective January 2026.

This guide covers every confirmed 2026 fee schedule, sample reimbursement rates, and step-by-step instructions for calculating your payment.

Quick Summary:

• Mississippi DOM has released multiple confirmed fee schedules effective January 2026
• Schedules cover dental (CDT codes), behavioral health (CPT/HCPCS), RHC, ASC, and PPEC services
• The Outpatient Hospital (OPPS) update is pending — next release is July 1, 2026
• Reimbursement rates vary by service type, provider level, and applicable modifiers
• Fee schedules are not a guarantee of payment — always verify through the DOM Provider Portal

What Is the Mississippi Medicaid Fee Schedule?

The Mississippi Medicaid fee schedule is the official list of reimbursement rates the state pays to healthcare providers for covered services. It is published and maintained by the Mississippi Division of Medicaid (DOM) and updated on a regular cycle throughout the year.

Each fee schedule is organized by service category and uses standardized billing codes — CPT codes for medical and behavioral health services, CDT codes for dental services, and HCPCS codes for supplies and equipment. Providers must use the correct fee schedule for their service type to find the applicable rate.

Why the Fee Schedule Matters

Providers use the fee schedule to estimate payment before submitting a claim. Patients can also use it to understand what services are covered and how much the state will pay on their behalf.

Knowing the fee schedule helps avoid billing errors and claim denials. It also helps providers plan for services where reimbursement rates may be lower than expected.

Who Sets the Rates?

The Mississippi DOM sets state Medicaid rates. For some services, Mississippi aligns its rates with the federal Medicare Physician Fee Schedule published annually by the Centers for Medicare & Medicaid Services (CMS). State-specific rates are published directly on the DOM website.

Confirmed 2026 Mississippi Medicaid Fee Schedules

Mississippi DOM has officially published several fee schedules with effective dates in 2026. The schedules listed below are sourced directly from official DOM publications and CMS guidance.

Each schedule applies to a specific category of service. You must use the correct schedule for your provider type — a physician CPT code cannot be cross-applied to a dental CDT schedule.

Dental Services Fee Schedule (CDT Codes)

Effective Date: January 2026 (updated February 2026)
Status: Active

The dental fee schedule covers reimbursement for dental procedure codes using the Current Dental Terminology (CDT) code set. Rates are subject to National Correct Coding Initiative (NCCI) edits, which means certain code combinations may be bundled or denied.

Key things to check in the dental fee schedule file:

• Look for the “Fee” or “Rate” column next to each CDT code
• Check “Min Age” and “Max Age” columns — some services are only covered for patients within a specific age range
• Download: Dental Fee Schedule – Feb 2026 (Excel) from the Mississippi DOM fee schedules page

Sample 2026 Dental Reimbursement Rates:

Source: Mississippi Medicaid Dental Services Fee Schedule – February 2026

Behavioral Health Services Fee Schedule (CPT/HCPCS Codes)

Effective Date: January 2026
Status: Active

The behavioral health fee schedule covers reimbursement for mental health and substance use disorder services. This schedule uses CPT and HCPCS codes and includes separate rates based on provider credential level.

Important notes for behavioral health providers:

• Rates differ depending on whether the rendering provider holds a Master’s degree or is a Physician/Psychiatrist
• Some rates change when a modifier is used (for example, modifier “HW” applies to state agency-based providers)
• The fee schedule is published for informational purposes — it does not guarantee reimbursement
• Download: Behavioral Health Services Fee Schedule – Jan 2026 (Excel) from the DOM website

Sample 2026 Behavioral Health Reimbursement Rates:

Source: Mississippi Medicaid Behavioral Health Services Fee Schedule – January 2026

Rural Health Clinics (RHC) – Prospective Payment System (PPS)

Effective Dates: January 1, 2026 – December 31, 2026
Status: Active

Rural Health Clinics are reimbursed under the Prospective Payment System (PPS), not standard fee-for-service. This means your clinic receives a per-encounter rate that is specific to your facility — not a rate per individual CPT code.

The 2026 PPS rates for both core services and other ambulatory services have been officially established. To find your facility’s encounter rate, download the RHC PPS Rates 2026 (Excel) file from the DOM fee schedules page.

Source: Mississippi Medicaid RHC PPS Rates 2026

Ambulatory Surgical Centers (ASC)

Effective Dates: January 2026 and March 2026 updates available
Status: Active

The DOM has published ASC fee schedules for Medical and Surgical Services under the Ambulatory Surgical Center category. Updates were made effective in both January and March of 2026, so providers should confirm they are using the most current version.

These schedules are available directly on the Mississippi DOM Fee Schedules and Rates page.

Source: Mississippi DOM Fee Schedules and Rates

Prescribed Pediatric Extended Care (PPEC)

Effective Dates: January 2026 and February 2026 updates listed
Status: Active

PPEC fee schedule updates were released for both January and February 2026. Providers of prescribed pediatric extended care services should download the most recent version to confirm current rates.

Source: Mississippi DOM Fee Schedules and Rates

Fee Schedules Pending for 2026

Not all 2026 fee schedules have been released yet. Some follow a fixed federal or state update cycle. Here is the status as of March 2026.

Understanding the pending schedules helps providers plan ahead and avoid submitting claims under outdated rates.

Outpatient Prospective Payment System (OPPS)

Anticipated Update: July 1, 2026
Current Status: The July 1, 2026 schedule has not yet been released (as of March 2026)

Mississippi Medicaid updates outpatient hospital rates every year on July 1. The rates are calculated using the final Medicare Outpatient Addendum B and C published by CMS as of April 1 of the same year.

Until the new schedule is released, providers should use the fee schedule effective from July 1, 2025. That schedule remains valid through June 30, 2026.

Source: Mississippi Medicaid State Plan Amendment (OPPS Methodology)

General Physician Fee Schedule

Federal Context: CMS released the 2026 Medicare Physician Fee Schedule effective January 1, 2026. Mississippi Medicaid often aligns specific codes and methodologies with federal updates.

As of March 2026, a distinct comprehensive Mississippi Physician Fee Schedule document for 2026 has not been separately published beyond the specific service categories (dental, behavioral health) listed above. Providers billing under physician codes should reference the applicable service-specific schedule or contact the DOM Provider Portal for guidance.

Source: CMS Physician Fee Schedule 2026

How to Calculate Your Mississippi Medicaid Reimbursement

Mississippi Medicaid does not offer a single calculator tool for all services. You need to locate the correct fee schedule for your specific provider type and then follow a simple calculation process.

This section walks you through each step so you can confidently estimate your reimbursement before submitting a claim. For a broader comparison across states, see our resource on Medicaid fee schedule 2026.

Step 1: Find the Right Fee Schedule

Reimbursement rates are strictly organized by service type. Always match your billing codes to the correct schedule:

• CDT codes (dental) → Use the Dental Services Fee Schedule
• CPT/HCPCS codes (medical or behavioral health) → Use the Behavioral Health or applicable medical schedule
• RHC encounters → Use the RHC PPS Rates file
• Outpatient hospital services → Use the current OPPS schedule (July 1, 2025 version until July 1, 2026)

You cannot apply a code from one schedule to a different service category. Doing so will result in a claim denial.

Step 2: Identify Your Billing Codes

List all CPT or CDT codes for the visit or encounter. Be specific — the correct code is essential for finding the right rate.

If you are billing behavioral health services, note the provider’s credential level. Rates differ for Master’s-level clinicians versus physicians.

Step 3: Check for Modifiers

Some fee schedules include rate adjustments based on modifiers. For example, modifier “HW” in the behavioral health schedule applies when services are provided through a state agency.

Always review the modifier column in the schedule before finalizing your rate. Overlooking a modifier can result in underpayment or a denied claim.

Step 4: Add Up the Fees

Once you have identified the correct rate for each billing code, total the fees for all services rendered during the visit.

Use the “Fee” or “Rate” column in the downloaded schedule file. Do not rely on memory or outdated printouts — always confirm you are using the current 2026 file.

Step 5: Apply Any Co-pays

Most adult Medicaid beneficiaries have a small co-pay — typically around $3.00 per visit. However, many beneficiary categories are exempt from co-pays entirely, including children, pregnant women, and emergency services.

Subtract any applicable co-pay from the total after calculating the base reimbursement. If you are unsure whether a co-pay applies, check the patient’s eligibility through the DOM Provider Portal.

Important Notices for Providers

Mississippi Medicaid fee schedules are published to help providers estimate reimbursement. There are several important limitations to keep in mind.

Always verify the patient’s current eligibility before providing services. Eligibility status can change, and a valid fee schedule does not guarantee that a specific claim will be paid.

Fee Schedules Are Not a Payment Guarantee

The Mississippi DOM explicitly notes that fee schedules are for informational purposes only. Payment is subject to eligibility verification, claim submission requirements, NCCI edits, and prior authorization rules where applicable.

Always verify coverage and eligibility through the Mississippi Division of Medicaid Provider Portal before rendering services.

Schedules Are Subject to Change

Fee schedules can be updated at any time during the year. New effective dates may be issued with little advance notice. Providers should check the DOM website regularly and download fresh copies of any schedule before billing.

Who Qualifies for Mississippi Medicaid?

Understanding who is covered helps providers confirm patient eligibility before billing. Mississippi Medicaid covers low-income adults, children, pregnant women, elderly individuals, and people with disabilities who meet income and categorical requirements.

You can also check income thresholds for other states in our comprehensive Medicaid income limits by state in 2026 resource.

Key Eligibility Categories

Mississippi Medicaid covers several distinct groups. Each group may have different covered services and reimbursement rules:

• Children (CHIP and traditional Medicaid) – covered through age 18 based on household income
• Pregnant women – covered for pregnancy-related services and postpartum care
• Adults with disabilities – covered through SSI-linked and waiver programs
• Elderly individuals (65+) – covered for nursing facility care and home and community-based services
• Low-income adults – Mississippi has not expanded Medicaid under the ACA, so coverage for childless adults remains very limited

Frequently Asked Questions

Sources & Disclaimer

Sources:

• Mississippi Division of Medicaid – Fee Schedules and Rates: https://www.medicaid.ms.gov
• CMS Physician Fee Schedule 2026: https://www.cms.gov/medicare/physician-fee-schedule
• Medicaid.gov – General Medicaid Program Information: https://www.medicaid.gov

Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. For official eligibility and billing guidance, contact the Mississippi Division of Medicaid directly or visit Medicaid.gov.

Last Updated: March 2026 | Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against official Mississippi DOM and CMS publications