Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against Medicaid.gov and Virginia DMAS official guidelines | Last Updated: August 2026
Quick Summary
- DMAS (the Virginia Department of Medical Assistance Services) sets all Medicaid fee schedules.
- Virginia’s new two-year budget became law on June 29, 2026.
- The current period is SFY 2027. It runs from July 1, 2026 through June 30, 2027.
- ABA therapy now has a default limit of 20 hours per week. Families can ask for more hours with medical proof.
- Personal care, respite, and companion care rates were set to rise 20% starting July 1, 2026.
- Always confirm exact rates at the DMAS website. DMAS updates its files often.
- 🔗 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 shows how much Medicaid pays providers for each service.
DMAS sets these rates every state fiscal year. The current period, SFY 2027, runs from July 1, 2026 through June 30, 2027.
Who Sets Virginia Medicaid Rates?
DMAS is the state agency in charge of rates. DMAS posts all rate files on its official rate-setting page at dmas.virginia.gov.
Big rate changes also need federal approval. The Centers for Medicare & Medicaid Services (CMS) approves these changes.
Why Do Fee Schedules Matter?
Fee schedules affect every Medicaid provider in Virginia. Doctors, hospitals, home health agencies, and nursing homes all depend on these rates.
Low rates can push providers to stop taking Medicaid patients. That hurts access to care for millions of Virginians.
Physician & CPT/HCPC Procedure Fees
DMAS shares CPT and HCPC procedure fees through an online tool. These rates cover doctor visits, dental care, and durable medical equipment (DME).
You can search rates by CPT code and service date. Use the DMAS Procedure Fee Files portal to look them up.
How to Look Up a CPT Code Rate
- Go to the DMAS CPT Code Lookup Tool.
- Enter your CPT code and service date.
- Select your provider type: physician, dental, or DME.
- Download the CSV file if you need bulk data.
What Codes Are Covered?
DMAS lists rates for three main groups:
- Physician and professional services (CPT codes)
- Dental services (CDT codes)
- Durable Medical Equipment (HCPCS codes)
Anesthesia rates are listed in a separate file on the DMAS portal.
⚠️ Note: DMAS does not publish one single document with every rate. Always use the DMAS lookup tool for the most current numbers.
Hospital Fee Schedule (Inpatient & Outpatient)
CMS approved Virginia’s hospital fee schedule for SFY 2026 on September 9, 2025. This approval covered both inpatient and outpatient care.
The approval applies to non-state, government-owned acute care hospitals.
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 applied to non-state government-owned acute care hospitals.
- This increase added up to $74,610,061 to capitation rates for that period.
- SFY 2027 hospital rate approvals should post on Medicaid.gov once CMS reviews them. Check the DMAS portal for the latest status.
Nursing Facility Rates
Virginia raised the cost benchmark used to set nursing home base rates. The benchmark moved from the 50th percentile to the 59th percentile of Day Weighted Median costs.
This change means nursing homes get higher base payments.
SFY 2026 Nursing Facility Funding
| Item | Amount |
|---|---|
| Base rate reform (2-year total) | $21.65 million/year ($43.3M total) |
| Value-Based Purchasing (VBP) Program | $40.8 million (SFY 2025 and SFY 2026) |
- DMAS and stakeholders built a plan to redesign nursing home payments for SFY 2027.
- The VBP program rewards facilities that meet quality goals.
⚠️ Note: DMAS has not published one document with every facility’s exact per-diem rate. Contact DMAS directly for facility-specific numbers.
Home Health Rates
DMAS publishes home health rates in a web file on its rate-setting page. This file shows the rates currently in effect.
How to Access Home Health Rates
Download the current Home Health Rates Web File from the DMAS Rate-Setting Page.
Exact per-visit and per-hour amounts are not summarized in one public document. DMAS updates these files on a regular basis.
What Home Health Services Are Covered?
Virginia Medicaid home health benefits usually include:
- Skilled nursing visits
- Physical, occupational, and speech therapy
- Home health aide visits
- Medical supplies and equipment
Check your Medicaid eligibility before you request home health services.
Developmental Disability (DD) Waiver Rates
DMAS sets DD waiver rates for three programs: Building Independence (BI), Family & Individual Support (FIS), and Community Living (CL).
Group homes, supported living, in-home supports, community engagement, and day support services received a 3% rate increase in the 2024–2026 budget cycle.
DD Waiver Rate Advocacy
A DMAS rate study recommended a 28% average increase across all DD waiver services. Most of that increase was not included in the budget.
Providers and families testified to the General Assembly in January 2026. They asked for higher rates to help agencies keep staff.
Caregivers in the CCC Plus waiver program in Northern Virginia earned about $17.97 an hour in early 2026. Advocates say this is too low to retain workers.
⚠️ Note: Check the DMAS Rate-Setting Page for the confirmed DD waiver rate for the new SFY 2027–2028 budget cycle.
Personal Care Services: Rate Increase Now Signed Into Law
Virginia’s 2026–2028 budget raises Medicaid personal care, respite, and companion care rates. The increase is 20%, effective July 1, 2026, with another 5% planned for July 1, 2027.
Governor Abigail Spanberger signed this budget into law on June 29, 2026.
Personal Care Rate Background
| Region | SFY 2026 Rate | Recommended Rate (Burns & Associates study) |
|---|---|---|
| Rest of Virginia | $19.83/hour | $31.21/hour |
| Northern Virginia | Not specified | $33.89/hour |
The recommended rates above come from a study cited by the Virginia Personal Care Providers organization.
⚠️ Note: The 20% increase is now law, but exact updated per-hour dollar amounts can vary by region and program type. Confirm the current rate at the DMAS Rate-Setting Page before billing.
2026–2028 Budget Changes Affecting Provider Rates
Virginia’s new budget includes a mix of increases and cost controls. Here is what changed and what is still uncertain.
| Change | Status |
|---|---|
| ABA therapy limited to 20 hours/week by default | Confirmed. Effective July 1, 2026. Families can request more hours with medical documentation. |
| Personal care rate increase (20%, then 5%) | Confirmed. Signed into the budget, effective July 1, 2026. |
| Cap on adult dental benefits at $2,000/year | Was proposed and debated in early 2026. Confirm final status at DMAS before relying on this. |
| Suspend automatic provider inflation adjustments | Was proposed to save about $238 million. Confirm final status at DMAS. |
These figures reflect the 2026–2028 biennium budget signed on June 29, 2026. Confirm any single rate at Medicaid.gov or the Virginia Legislative Information System before you rely on it.
Virginia Workers’ Comp Fee Schedule Is Different
Some providers search “Virginia Medical Fee Schedule” and find Workers’ Compensation rates by mistake. These are not Medicaid rates.
The Virginia Workers’ Compensation Commission publishes its own fee schedule. The current one runs from January 1, 2026 through December 31, 2027, and only applies to injured workers.
Always use the DMAS portal for Medicaid-specific rates.
Who Qualifies for Virginia Medicaid?
Virginia expanded Medicaid under the Affordable Care Act. More adults qualify now than ever before.
You may qualify based on income, household size, age, disability, or pregnancy. Use our Medicaid Eligibility Calculator 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 means Federal Poverty Level. Most groups use Modified Adjusted Gross Income (MAGI) to count income.
Check Medicaid Income Limits by State to compare Virginia to other states.
Where to Find Official Virginia Medicaid Rate Files
| Resource | Official Link |
|---|---|
| CPT/HCPC Procedure Fee Lookup | DMAS Procedure Fee Files |
| DD Waiver Rates | DMAS Rate Setting |
| CCC Plus Waiver Rates | DMAS Rate Setting |
| Home Health Rates | DMAS Rate Setting |
| Hospital Fee Schedule Approvals | Medicaid.gov |
| Full Budget Text | Virginia Legislative Information System |
Frequently Asked Questions (FAQ)
Q: What is the Virginia Medicaid fee schedule right now?
A: The current period is SFY 2027, running July 1, 2026 through June 30, 2027. DMAS sets these rates for physician services, hospitals, nursing homes, home health, and waiver programs. Look up specific CPT code rates at the DMAS portal.
Q: How do I look up a specific CPT code rate?
A: Go to the DMAS Procedure Fee Files page. Enter your CPT code and service date. You can download bulk data as a CSV file. No single document lists every rate.
Q: Did Virginia increase Medicaid personal care rates in 2026?
A: Yes. The signed 2026–2028 budget raises personal care, respite, and companion care rates by 20% starting July 1, 2026, with another 5% planned for July 1, 2027. Confirm your exact rate at DMAS before billing.
Q: Is there a new limit on ABA therapy in Virginia Medicaid?
A: Yes. As of July 1, 2026, ABA therapy has a default limit of 20 hours per week. This is not an absolute cap — families can request more hours with medical documentation showing it’s necessary.
Q: Are DD waiver rates going up in Virginia?
A: DD waiver services got a 3% increase in the 2024–2026 budget cycle. A rate study recommended a 28% increase, but most of that was not funded. Confirm the current DD waiver rate for the new budget cycle at DMAS.
Q: Is the Virginia Workers’ Compensation fee schedule the same as Medicaid?
A: No. These are two separate programs. The Workers’ Compensation fee schedule only applies to injured workers. Virginia Medicaid rates are set by DMAS and apply only to Medicaid-covered services.
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
- Office of the Governor of Virginia — 2026–2028 budget signing statement, June 29, 2026
- Virginia Legislative Information System — budget.lis.virginia.gov
- Virginia Healthcare Association (VHCA) — nursing facility budget summary
- Virginia Personal Care Providers (VAPCP) — reimbursement rate study
- 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: August 2026 | Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against official DMAS and Medicaid.gov guidelines
