Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against Medicaid.gov and Virginia DMAS official guidelines | Last Updated: May 2026
Quick Summary
- Virginia Medicaid fee schedules are set by the Virginia Department of Medical Assistance Services (DMAS)
- SFY 2026 covers July 1, 2025 through June 30, 2026
- CMS approved hospital fee schedules for this period in September 2025
- Nursing facility base rates increased to the 59th percentile cost benchmark
- DD waiver services received a 3% rate increase effective July 1, 2025
- Personal care rates and inflation adjustments face proposed budget changes
- 🔗 Use our Medicaid Fee Schedule in 2026 guide to compare rates across programs
What Is the Virginia Medicaid Fee Schedule?
The Virginia Medicaid fee schedule is a list of payment rates. It tells providers how much Medicaid will pay for each service.
DMAS sets and updates these rates every state fiscal year. The current period — SFY 2026 — runs from July 1, 2025 through June 30, 2026.
Who Sets Virginia Medicaid Rates?
The Virginia Department of Medical Assistance Services (DMAS) is the agency in charge. DMAS publishes all rate files on its official rate-setting portal at dmas.virginia.gov.
Federal approval from the Centers for Medicare & Medicaid Services (CMS) is required for major rate changes. CMS approved Virginia’s hospital fee schedule for SFY 2026 on September 9, 2025.
Why Do Fee Schedules Matter?
Fee schedules affect every Medicaid provider in Virginia. Doctors, hospitals, home health agencies, and nursing homes all rely on these rates to get paid.
Low rates can push providers to stop accepting Medicaid. That affects access to care for millions of Virginians.
Physician & CPT/HCPC Procedure Fees in 2026
DMAS publishes CPT and HCPC procedure fees through its online lookup tool. These cover professional services, physician visits, dental, and durable medical equipment (DME).
Providers can search rates by service date and CPT code directly at the DMAS Procedure Fee Files portal.
How to Look Up CPT Code Rates
DMAS does not publish one single PDF with all rates. Instead, providers must use the online tool.
Here is how to find a specific rate:
- Go to the DMAS CPT Code Lookup Tool
- Enter your CPT code and service date
- Select the provider type (physician, dental, DME)
- Download the CSV file for bulk data (CPT Part 1 covers codes 0001F–29999)
What Codes Are Covered?
DMAS lists rates for three main categories:
- Physician/professional services (CPT codes)
- Dental services (CDT codes)
- Durable Medical Equipment (HCPCS codes)
Anesthesia reimbursement rates are listed separately on the DMAS portal.
⚠️ Note: No single public document summarizes all SFY 2026 physician rates by CPT code. Always use the DMAS lookup tool for the most accurate, current rates.
Hospital Fee Schedule 2026 (Inpatient & Outpatient)
CMS approved Virginia’s hospital fee schedule for both inpatient and outpatient services covering SFY 2026. This approval was granted on September 9, 2025.
The approval covers all non-state government-owned acute care hospitals in Virginia.
Key Hospital Rate Details
| Service Type | Payment Method | Period Covered |
|---|---|---|
| Inpatient Hospital (IPH) | Fee schedule | July 1, 2025 – June 30, 2026 |
| Outpatient Hospital (OPH) | Fee schedule | July 1, 2025 – June 30, 2026 |
- A uniform rate increase applies to non-state government-owned acute care hospitals
- This increase is built into capitation rates through a separate payment of up to $74,610,061 for the rating period
- Official approval details are on Medicaid.gov
Nursing Facility Rates 2026
Virginia’s General Assembly passed the 2025 budget with major changes for nursing homes. The key change was raising the cost benchmark used to set base rates.
The benchmark moved from the 50th percentile to the 59th percentile of Day Weighted Median costs. This means nursing homes receive higher base payments.
SFY 2026 Nursing Facility Funding Highlights
| Item | Amount |
|---|---|
| Base rate reform (2-year allocation) | $21.65 million/year ($43.3M total) |
| Value-Based Purchasing (VBP) Program | $40.8 million (SFY 2025 and SFY 2026) |
- DMAS and stakeholders are working together to redesign payment delivery for SFY 2027 (starting July 1, 2026)
- The VBP program rewards facilities that meet quality benchmarks
⚠️ Note: The exact per-diem rate table for individual nursing facilities in SFY 2026 is not yet available in a single public document. Contact DMAS directly for facility-specific rates.
Home Health Rates 2026
DMAS has published the SFY 2026 Home Health Rates Web File on its official rate-setting page. This file confirms current rates are in effect for home health services.
How to Access Home Health Rates
Providers should download the SFY 26 Home Health Rates Web File directly from the DMAS Rate-Setting Page.
Specific per-visit and per-hour dollar amounts are not published in a public summary document. DMAS updates these files regularly.
What Home Health Services Are Covered?
Virginia Medicaid home health services typically include:
- Skilled nursing visits
- Physical, occupational, and speech therapy
- Home health aide visits
- Medical supplies and equipment
Check your Medicaid Eligibility in 2026 to confirm coverage before requesting home health services.
Developmental Disability (DD) Waiver Rates 2026
DMAS publishes SFY 2026 DD Waiver rates for three programs: Building Independence (BI), Family & Individual Support (FIS), and Community Living (CL).
A 3% rate increase was authorized for specified DD waiver services effective July 1, 2025.
Which Services Got the 3% Increase?
The increase applies to the following services:
- Group Homes
- Supported Living
- In-home Supports
- Community Engagement
- Day Support
DD Waiver Rate Advocacy in 2026
A DMAS rate study recommended average increases of about 28% across all DD waiver services. However, many of those increases were not included in the governor’s budget.
Providers and parents testified before the General Assembly in January 2026, calling for higher rates. Caregivers in the CCC Plus waiver program in Northern Virginia earned about $17.97/hour as of early 2026. Advocates say this is not enough to keep staff.
SFY 2026 CCC Plus Waiver Rates are published on the DMAS Rate-Setting Page.
Personal Care Services: Proposed 2026 Rate Increase
Virginia’s 2026 budget included a proposed amendment (Item 291, #17h) to raise personal care rates. This proposal would give a 20% rate increase on July 1, 2026, followed by an additional 5% increase after that.
Current vs. Recommended Personal Care Rates
| Region | Current Medicaid Rate | Burns & Associates Recommended Rate |
|---|---|---|
| Rest of Virginia | $19.83/hour | $31.21/hour |
| Northern Virginia | Not specified | $33.89/hour |
These figures are based on a rate study cited by the Virginia Personal Care Providers organization as of early 2026.
⚠️ Note: As of May 2026, it has not been confirmed whether the final budget passed or vetoed this amendment. Check the Virginia Legislative Information System for the latest status.
2026 Budget Proposals Affecting Provider Rates
Virginia’s introduced 2026 budget included several cost-saving measures. These proposals could reduce or freeze certain Medicaid provider payments.
Here is a summary of key proposals:
| Proposal | Estimated Impact |
|---|---|
| Suspend automatic provider inflation adjustments | Save ~$238 million |
| Cap adult dental benefits at $2,000/year | Limits dental coverage |
| Limit Applied Behavior Analysis (ABA) to 20 hrs/week | Requires autism diagnosis |
| Cap personal care services at 56 hrs/week | Exception process available |
The total Medicaid forecast increase driving these proposals was about $432 million in total funds, as of the January 2026 legislative briefing.
These are proposals. Confirm final enactment at the Virginia Legislative Information System or Medicaid.gov.
Important: Virginia Workers’ Comp Fee Schedule Is Different
Some providers search for the “Virginia Medical Fee Schedule 2026” and find Workers’ Compensation rates. These are not Medicaid rates.
The Virginia Workers’ Compensation Commission publishes its own medical fee schedules. The 2026 Workers’ Comp fee schedules (effective January 1, 2026 through December 31, 2027) apply only to injured workers. They do not apply to Medicaid patients or services.
Always use the DMAS portal for Medicaid-specific rates.
Who Qualifies for Virginia Medicaid in 2026?
Virginia expanded Medicaid under the Affordable Care Act (ACA). This means more adults qualify than ever before.
You may qualify based on income, household size, age, disability, or pregnancy. Use our Medicaid Eligibility Calculator in 2026 to check your status in minutes.
Virginia Medicaid Eligibility Groups
| Group | Income Limit (% FPL) |
|---|---|
| Adults (19–64, ACA expansion) | Up to 138% FPL |
| Children (CHIP/Medicaid) | Up to 200% FPL |
| Pregnant women | Up to 205% FPL |
| Seniors (65+) | Based on income and assets |
| People with disabilities | Based on SSI/income rules |
FPL = Federal Poverty Level. Income limits are based on Modified Adjusted Gross Income (MAGI) for most groups.
Check Medicaid Income Limits by State in 2026 to compare Virginia to other states.
Where to Find Official Virginia Medicaid Rate Files
Use these official resources to access SFY 2026 rate data:
| Resource | Official Link |
|---|---|
| CPT/HCPC Procedure Fee Lookup | DMAS Procedure Fee Files |
| SFY 2026 DD Waiver Rates | DMAS Rate Setting |
| SFY 2026 CCC Plus Waiver Rates | DMAS Rate Setting |
| SFY 2026 Home Health Rates | DMAS Rate Setting |
| CMS Hospital Fee Schedule Approval | Medicaid.gov |
Frequently Asked Questions (FAQ)
Q: What is the Virginia Medicaid fee schedule for 2026?
A: The Virginia Medicaid fee schedule for SFY 2026 covers July 1, 2025 through June 30, 2026. It is set by DMAS and includes rates for physician services, hospitals, nursing homes, home health, and waiver programs. Providers can look up specific CPT code rates at the DMAS rate-setting portal at dmas.virginia.gov.
Q: How do I look up a specific CPT code rate in Virginia Medicaid 2026?
A: Go to the DMAS Procedure Fee Files page at dmas.virginia.gov. Enter your CPT code and service date to find the current Medicaid reimbursement rate. Bulk data is available as a downloadable CSV file. No single public PDF lists all rates in one place.
Q: Did Virginia increase Medicaid nursing home rates in 2026?
A: Yes. The Virginia General Assembly raised the nursing facility base rate benchmark from the 50th percentile to the 59th percentile of Day Weighted Median costs. DMAS also allocated $21.65 million per year for base rate reform and $40.8 million for the Value-Based Purchasing program in both SFY 2025 and SFY 2026.
Q: What happened to Virginia Medicaid personal care rates in 2026?
A: A 2026 budget amendment proposed a 20% rate increase for personal care services starting July 1, 2026, plus an additional 5% after that. As of May 2026, the current rate for Rest of Virginia is $19.83/hour, well below the $31.21/hour recommended by a Burns & Associates rate study. Final budget status has not been confirmed.
Q: Are DD waiver rates going up in Virginia in 2026?
A: DD waiver rates for specific services received a 3% increase effective July 1, 2025. A DMAS rate study recommended average increases of about 28%, but many of those were not included in the governor’s budget. Providers and families continue to advocate for higher rates to address staffing shortages.
Q: Is the Virginia Workers’ Compensation fee schedule the same as Medicaid?
A: No. These are two completely separate programs. The Virginia Workers’ Compensation Commission fee schedule applies only to injured workers under the Workers’ Compensation Act. Virginia Medicaid rates are set by DMAS and apply to Medicaid-covered services only. Always use the DMAS portal for Medicaid provider rates.
Sources & Disclaimer
Sources:
- Virginia Department of Medical Assistance Services (DMAS) — dmas.virginia.gov/for-providers/rates-and-rate-setting/
- Centers for Medicare & Medicaid Services (CMS) — medicaid.gov
- Virginia Healthcare Association (VHCA) — SFY 2026 nursing facility budget summary
- Virginia Personal Care Providers (VAPCP) — 2025–2026 reimbursement talking points
- Virginia Legislative Information System — budget.lis.virginia.gov
- Healthcare.gov Medicaid overview — healthcare.gov/medicaid-chip/
Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. For official Virginia Medicaid provider rates, contact DMAS directly or visit dmas.virginia.gov. For general Medicaid information, visit Medicaid.gov.
Last Updated: May 2026 | Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against official DMAS and Medicaid.gov guidelines
