Virginia Medicaid Fee Schedule (SFY 2027): DMAS Rates by Service Type

Updated: August 24, 2026

Virginia Medicaid rates changed again for State Fiscal Year (SFY) 2027, which began July 1, 2026. For providers, the important point is that there is not one universal “Virginia Medicaid fee schedule” containing every reimbursement amount.

The Virginia Department of Medical Assistance Services (DMAS) publishes different rate files for physician and professional services, hospitals, nursing facilities, home health, developmental disability waivers, the CCC Plus Waiver, behavioral health and other services.

This guide explains where to find the current rates, what changed for SFY 2027, how to look up a CPT or HCPCS code, and what providers should know about fee-for-service and Cardinal Care managed care reimbursement.

Important: For billing, use the current DMAS rate file for the applicable service date. Rate sheets can be corrected or revised, and managed care plans may take additional time to implement newly posted rates.

Virginia Medicaid Fee Schedule: What Is Current for SFY 2027?

SFY 2027 runs from July 1, 2026, through June 30, 2027.

DMAS has published SFY 2027 rate information and states that the official rate sheets on its Rate Setting page are the source for current reimbursement amounts. For certain waiver services, DMAS also issued a July 2026 bulletin confirming that updated SFY 2027 rates are posted.

The most useful way to think about the Virginia Medicaid fee schedule is by service category:

DMAS maintains these categories on its official Rate Setting page.

How to Look Up a Virginia Medicaid CPT or HCPCS Rate

For a specific procedure, code-based lookup is more reliable than using a general rate table.

DMAS provides a Procedure Fee Files & CPT Codes section containing CPT, HCPCS, dental procedure and revenue-code information.

Step 1: Identify the billing code

Find the CPT, HCPCS, CDT or other applicable procedure code on the claim or fee schedule you are reviewing.

Step 2: Check the service date

The same code can have different reimbursement amounts during different fiscal years. Make sure you are reviewing the rate applicable to the date of service, not simply the newest file on the website.

Step 3: Confirm the provider or service category

Virginia Medicaid rates can differ depending on whether the claim involves professional services, dental services, DME, institutional services, a waiver program or another category.

Step 4: Check modifiers and billing rules

The fee amount alone does not tell you whether a claim will pay. Modifier requirements, authorization, provider enrollment, place of service, units, benefit limitations and managed-care requirements can also affect payment.

Step 5: Use the official DMAS file for final billing

DMAS specifically directs providers to its Procedure Fee Files & CPT Codes section for procedure-code rates.

Virginia Medicaid Personal Care Rates: What Changed in 2026?

One of the most important SFY 2027 changes is the legislated increase for certain personal care and home- and community-based services.

Virginia’s 2026 budget provides for a 20% increase effective July 1, 2026 for agency-directed and consumer-directed personal care, respite care and companion care services covered under the specified Medicaid waiver and EPSDT programs.

The budget also provides for another 5% increase effective July 1, 2027.

Do not confuse the 2025 rates with the SFY 2027 rates

DMAS published these rates effective July 1, 2025:

These are SFY 2026 rates, not the current SFY 2027 rates.

Because the law requires a 20% increase beginning July 1, 2026, those 2025-published amounts imply approximately:

*These figures are mathematical calculations from the previously published DMAS rates and the legislated 20% increase.

Do not use these calculations as the final billing rate when an official SFY 2027 DMAS rate sheet is available for the applicable service. The official DMAS rate file controls.

That distinction matters because providers should not assume that a percentage calculation is a substitute for the actual published rate file.

Why the Personal Care Increase Matters

The personal care increase affects services delivered in home- and community-based settings and is one of the clearest reimbursement changes in the new budget.

The 2026 budget language covers both agency-directed and consumer-directed personal care, respite and companion care services in the specified programs.

For agencies and billing departments, that means the correct workflow is:

1. Identify the exact service and procedure code.
2. Confirm whether the service is agency-directed or consumer-directed.
3. Confirm the applicable region.
4. Confirm the date of service.
5. Check the current SFY 2027 DMAS rate sheet.
6. If the member is in managed care, verify the applicable plan’s implementation and billing instructions.

Developmental Disability Waiver Rates for SFY 2027

Virginia has separate Medicaid rate information for the three primary Developmental Disability waiver programs:

• Building Independence (BI)
• Family & Individual Support (FIS)
• Community Living (CL)

DMAS lists dedicated SFY 2027 Developmental Disability Waiver rate information on its Rate Setting page.

The 2026 budget also authorized DMAS to update rates for selected DD waiver services using the 2025 DD Waiver Rate Study methodology.

The legislation specifically identifies services including Community Coaching, Community Engagement, Companion Care, Independent Living Supports, In-Home Support Services, Therapeutic Consultation and Workplace Assistance.

Because DD waiver reimbursement varies by service and billing unit, a single statewide “DD waiver hourly rate” would be misleading. Providers should use the applicable SFY 2027 DMAS rate sheet.

CCC Plus Waiver Rates for SFY 2027

The Commonwealth Coordinated Care Plus (CCC Plus) Waiver has its own SFY 2027 rate information.

DMAS lists the current SFY 2027 CCC Plus Waiver Rates on its provider Rate Setting page.

DMAS’s August 2026 waiver bulletin states that selected CCC Plus and DD Waiver services were updated effective July 1, 2026 and that the SFY 2027 rate sheets posted on the DMAS website are the official notification of those rates.

This is particularly important for providers billing home- and community-based services because the applicable amount can depend on the exact service, billing unit and program.

Physician Medicaid Rates and RBRVS

Virginia also uses a Resource Based Relative Value Scale (RBRVS) methodology for physician payments.

DMAS issued a bulletin confirming that RBRVS physician rates were updated effective July 1, 2026. The bulletin directs providers to the DMAS Procedure Fee Files & CPT Codes section for the applicable procedure-code rates.

That means a physician practice should not rely on a generic “Virginia Medicaid reimbursement percentage” when estimating payment.

Instead, check:

• CPT/HCPCS code
• Date of service
• Relevant DMAS rate file
• Applicable modifiers
• Provider type
• Place of service
• Authorization requirements
• Whether the member is fee-for-service or enrolled in managed care

Virginia Medicaid Fee-for-Service vs. Cardinal Care

Another common source of confusion is treating the DMAS fee-for-service rate as if it were automatically the exact amount every managed-care claim will pay.

Virginia Medicaid also operates Cardinal Care managed care. DMAS states that providers treating managed-care members must follow the applicable managed-care plan contract and that a managed-care plan may use different guidelines than those applicable to fee-for-service members.

DMAS also maintains a separate managed-care capitation section with FY2027 Cardinal Care rate reports and MCO contract rate sheets.

Why this matters for providers

Suppose you find a fee-for-service rate in a DMAS file.

That does not automatically mean:

“This is exactly what every Cardinal Care plan will pay me on every claim.”

Instead, confirm the member’s plan and the provider’s contract and billing requirements.

For the 2026 rate updates, DMAS said MCOs may need 30–60 days after rates are posted to finish updating their systems. DMAS also said MCOs are required to update reimbursement at the same percentage as revised fee-for-service rates for the applicable legislatively mandated changes, and that claims paid at old rates may be reprocessed after system updates.

What Providers Should Do When a Rate Has Not Updated Yet

A rate change can be legally effective before every payer’s billing system has finished implementing it.

DMAS’s August 2026 bulletin specifically explains this issue for SFY 2027. Providers may initially see claims processed under older amounts while MCO systems are being updated, with later reprocessing expected after implementation.

If you notice a payment that appears incorrect:

1. Verify the date of service.
2. Verify the exact rate sheet and code.
3. Check whether the claim was fee-for-service or managed care.
4. Review the applicable plan’s billing guidance.
5. Check whether DMAS or the MCO has announced a reprocessing period.
6. Keep documentation showing the rate applicable to the date of service.

For DMAS fee-for-service and rate-related disputes, providers can use the DMAS Appeals process. DMAS states that certain payment-rate appeals must be received within 30 days of the payment rate or total being published.

Home Health, Hospital and Nursing Facility Rates

Not every Virginia Medicaid service is paid through a simple CPT-based fee schedule.

Home health

DMAS publishes home health rate files separately from the CPT/HCPCS procedure fee files. The Rate Setting page contains the available home health rate files and related information.

Hospitals

Hospital reimbursement is also handled separately. DMAS maintains inpatient hospital rates and outpatient EAPG rates on its Rate Setting page.

Nursing facilities

Nursing facility reimbursement follows its own methodology and reporting requirements rather than a single physician-style CPT fee schedule. DMAS provides dedicated nursing-facility reimbursement information.

This is why a provider searching for a single spreadsheet containing “all Virginia Medicaid rates” may not find one. The state’s rate system is organized by program and service category.

Virginia Medicaid vs. Medicare Fee Schedule

Virginia Medicaid rates should not be confused with the Medicare Physician Fee Schedule.

CMS publishes Medicare Physician Fee Schedule payment files and a separate Medicare lookup tool. Medicare rates use their own federal methodology, including relative value units and geographic adjustments.

Virginia Medicaid has its own state-specific rate-setting system through DMAS.

So if you are deciding whether a particular CPT code is “well reimbursed,” compare:

• Virginia Medicaid FFS rate
• Applicable Cardinal Care reimbursement
• Medicare rate
• Commercial contract rates

Do not assume that a Medicare fee is the Virginia Medicaid fee.

How to Find the Official Virginia Medicaid Fee Schedule

The safest starting point is the Virginia DMAS Rate Setting page.

There you can access:

• CPT and HCPCS procedure fees
• Professional and physician rates
• Dental rates
• DME rates
• Anesthesia reimbursement
• Inpatient hospital rates
• Outpatient EAPG rates
• Home health files
• DD Waiver rates
• CCC Plus Waiver rates
• Managed care capitation information
• Other program-specific reimbursement resources

DMAS’s August 2026 bulletin specifically states that the posted SFY 2027 rate sheets are considered the official notification, with corrections or revisions noted on the official rate sheet.

Common Mistakes When Using the Virginia Medicaid Fee Schedule

1. Using the wrong fiscal year

A 2025 or SFY 2026 rate is not automatically the current SFY 2027 rate.

2. Using a rate without checking the region

Some services, especially personal care and related services, have different amounts for Northern Virginia and the rest of Virginia.

3. Ignoring the delivery model

Agency-directed and consumer-directed services can have different reimbursement amounts.

4. Treating a FFS rate as a universal managed-care payment

Cardinal Care plans have their own contracts and implementation requirements.

5. Looking only at the code

The code is only part of the reimbursement calculation. Date of service, modifiers, units, authorization and provider type may all matter.

6. Relying on an old article

Virginia Medicaid rates can change during a fiscal year. Always check the latest DMAS bulletin and rate sheet before billing.

Frequently Asked Questions

Bottom Line

The Virginia Medicaid fee schedule for SFY 2027 is not one single table. The correct reimbursement depends on the program, service, procedure code, date of service and, in many cases, whether the member is covered through fee-for-service Medicaid or a Cardinal Care managed-care plan.

The biggest current change is the legislated 20% increase effective July 1, 2026 for specified personal care, respite and companion care services, followed by a 5% increase scheduled for July 1, 2027.

For a claim you are preparing today, the safest workflow is:

Find the exact code → check the service date → open the current DMAS rate file → confirm the service/program → verify FFS vs. Cardinal Care requirements → then bill.

For official Virginia Medicaid reimbursement information, use the DMAS Rate Setting resources rather than an old third-party fee table. DMAS identifies its posted SFY 2027 rate sheets as the official notification for the current rates.