Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against West Virginia Bureau for Medical Services (BMS) and official state agency guidelines | Last Updated: June 2026
West Virginia Medicaid fee schedules for 2026 are managed by the Bureau for Medical Services (BMS) and its contracted Managed Care Organizations (MCOs). These schedules set how much providers get paid for each covered service.
This guide explains what changed in 2026, where to find official rates, and how to access the right files for your provider type.
Quick Summary:
- The Clinical Lab Fee Schedule is the most significant confirmed 2026 update, effective April 1, 2026.
- All fee schedules are posted at bms.wv.gov.
- Managed care rates are set by MCOs like The Health Plan (Mountain Health Trust).
- A proposed mental health rate increase (SB 994) did not pass in the 2026 legislative session.
- Community engagement requirements take effect January 1, 2027 — not yet in force.
- Want to know if a patient qualifies? Check our Medicaid Eligibility guide first.
What Is the West Virginia Medicaid Fee Schedule?
The West Virginia Medicaid fee schedule is the official list of payment rates for medical services covered by Medicaid. It tells providers exactly how much they will be reimbursed for each procedure code.
These rates apply to fee-for-service (FFS) Medicaid members and are set by the Bureau for Medical Services.
West Virginia Medicaid operates through two main delivery systems: fee-for-service (FFS) and managed care. Each system has its own fee structure, so providers must check the right source for their members.
Fee-for-Service vs. Managed Care
Under fee-for-service, BMS pays providers directly using rates listed in the official fee schedule files. Under managed care, providers contract with MCOs like The Health Plan. MCOs set their own rates within state guidelines, so providers must check MCO-specific fee files for exact amounts.
Who Sets the Rates?
BMS sets all FFS rates and posts them as downloadable PDF and Excel files. MCOs negotiate rates with providers separately. CMS federal guidelines, including Medicare conversion factors, also influence many West Virginia rate categories.
Why Fee Schedules Change
Rates are updated annually to reflect federal Medicare adjustments, state budget decisions, and legislative changes. Understanding updates helps providers plan billing accurately and avoid claim denials.
2026 Confirmed Fee Schedule Updates in West Virginia
West Virginia BMS has confirmed several fee schedule updates for 2026. The most significant is the Clinical Laboratory Fee Schedule, which took effect April 1, 2026.
Providers should download the most recent files directly from the BMS portal to ensure they are billing at current rates.
For context on how income thresholds affect your patients’ coverage eligibility, see Medicaid income limits by state in 2026.
Clinical Laboratory Fee Schedule (Effective April 1, 2026)
This is the most important confirmed 2026 update. BMS released a specific Excel file titled MCO - Clinical Lab Fee Schedule Effective 4-1-26 to 3-31-27.xlsx. This file contains verified reimbursement rates for lab HCPCS codes valid through March 31, 2027.
Providers billing for clinical lab services must use this updated file. Lab codes not listed in the 2026 schedule may not be reimbursable without prior authorization.
Mental Health Rate Proposal — Did NOT Pass
Senate Bill 994 was introduced in the 2026 Regular Session. It proposed that Medicaid reimbursement for certain mental health services match Medicare rates (Medicare parity). The bill was referred to the Committee on Health and Human Resources in February 2026 but did not advance. Providers should not expect any statutory Medicare-parity increase for mental health services based on this bill at this time.
Ambulance and DME — Aligned with Federal Updates
West Virginia reviews ambulance and durable medical equipment (DME) rates in alignment with CMS Medicare updates. CMS released the 2026 Ambulance Fee Schedule Public Use Files in May 2026. These files typically serve as a baseline for state rate adjustments. A specific 2026 state-only ambulance file is not separately highlighted, so providers should check the BMS portal directly.
West Virginia Medicaid Fee Schedule Categories 2026
BMS posts fee schedules across many service categories for 2026. All files are in PDF or Excel format and are available on the main BMS portal. Specific dollar amounts are inside the downloadable files — not displayed as text on the webpage itself.
For a full overview of how the Medicaid Fee Schedule 2026 works nationally, including how states align with CMS, visit our dedicated guide.
Physician (RBRVS) Fee Schedule
West Virginia uses a Resource-Based Relative Value Scale (RBRVS) system for physician payments. Updated physician fee schedule files for 2026 are available on the BMS portal under “Physician’s (RBRVS) Fee Schedule.” Providers must download the current Excel file for exact CPT code rates.
Dental Fee Schedule
BMS maintains a separate Dental Fee Schedule for 2026. This covers covered dental procedure codes and their Medicaid reimbursement amounts. The 2026 dental file is available for download on the BMS fee schedules page.
Durable Medical Equipment (DME) Fee Schedule
Two confirmed 2026 DME files are posted on the BMS portal:
- DME 2026 Competitive Bidding Schedule — Effective April 1, 2026 through March 31, 2027 (PDF and Excel)
- DME CY 2026 Fee Schedule — Effective April 1, 2026 through March 31, 2027 (PDF and Excel)
These files contain HCPCS code-level reimbursement rates for durable medical equipment. Access them at: BMS DME Fee Schedule Page.
Other Covered Service Categories
BMS also maintains 2026 fee schedule files for:
- Ambulance Services
- Ambulatory Surgery Center (ASC) Rates
- Anesthesia
- Applied Behavior Analysis (ABA)
- Emergency Department (ED)
- Home Health Agencies
- Hospice (County Rates)
- Nursing Facilities
- Private Duty Nursing
- Vision Services
- Waiver Program Rates (ADW, CSEDW, IDDW, TBIW)
- School-Based Health Services (SBHS)
Each category has a linked 2026 file. The presence of a code in a schedule does not guarantee coverage — providers must also confirm coverage in the applicable WV Medicaid provider manual.
School-Based Health Services (SBHS) — 2026 Expansion
BMS published a major SBHS expansion effective in 2026 through State Plan Amendment SPA 26-0001, filed March 31, 2026. This update expands which students and providers are covered under the school-based Medicaid program.
Who Is Now Eligible Under SBHS?
The eligible population now includes any Medicaid-enrolled youth with an IEP, IFSP, 504 Plan, other individualized health or behavioral health plan, or where medical necessity is established. This is a broader definition than previously applied.
New Provider Types Authorized to Bill SBHS
Three new provider types can now bill for SBHS services in 2026:
- Board Certified Behavior Analysts (BCBAs)
- Licensed Social Workers
- School Counselors
SBHS Projected Cost Increases
- FFY 2026: +$1,765,248 in Medicaid expenditures
- FFY 2027: +$3,309,841 in Medicaid expenditures
BMS notes that SBHS is financed entirely with federal dollars and is budget-neutral at the overall state level.
How to Access West Virginia Medicaid Fee Schedules
All official 2026 fee schedules are posted on the BMS website. Providers should not rely on third-party aggregators for rate data, as these may be outdated or incomplete.
Step 1: Go to the BMS Fee Schedules Portal
Visit: https://bms.wv.gov/providers/west-virginia-medicaid-fee-schedules
This is the master page for all West Virginia Medicaid FFS rate schedules.
Step 2: Select Your Service Category
Find your category on the portal (e.g., “Physician’s Fee Schedule,” “Dental Fee Schedule,” “DME Fee Schedule”). Each category has its own sub-page with linked files.
Step 3: Download the 2026 File
Look for files labeled “CY 2026” or with an effective date in 2026. Download the PDF or Excel version. Use the Excel version for searchable, code-level lookup.
Step 4: For Managed Care Rates, Check Your MCO
If your patient is in a managed care plan (such as Mountain Health Trust through The Health Plan), log in to the MCO’s provider portal. The Health Plan posts “Revenue Fee Files” and “Procedure Fee Audit Trails” for 2026. Access at: The Health Plan Provider Fee Schedules.
2026 Medicaid Eligibility Financial Thresholds (West Virginia)
These thresholds determine whether a patient qualifies for Medicaid services in West Virginia. They are separate from provider reimbursement rates but are important for understanding patient coverage.
| Eligibility Category | 2026 Limit |
|---|---|
| Long-Term Care (Nursing Home) — Income | $2,982/month (individual) |
| Asset Limit (Individual Applicant) | $2,000 |
| Community Spouse Resource Allowance | Up to $162,660 in joint assets |
These figures come from the West Virginia Medicaid planning eligibility guidelines for 2026. For a full breakdown by household size and program type, visit our Medicaid Eligibility guide.
Upcoming 2026–2027 Policy Changes Affecting Providers
West Virginia BMS and the Department of Human Services (DoHS) have announced upcoming changes that will affect Medicaid operations. These are not fee schedule changes but will impact patient enrollment and provider billing volumes.
Community Engagement Requirements — Effective January 1, 2027
New federal Medicaid community engagement (work requirement) rules will take effect January 1, 2027. Preparatory eligibility system changes will occur by October 1, 2026. Providers may see shifts in their Medicaid patient panels as eligibility is re-evaluated. The DoHS has launched WVMedicaidHelp.org as the primary resource for members and providers to learn about these requirements and exemptions.
CMS Ensuring Access Rule — Fee Schedule Transparency Deadline
Under the CMS “Ensuring Access to Medicaid Services” Final Rule, West Virginia BMS must make all FFS rate schedules easily accessible on a public website by July 1, 2026. Provider-specific rates that were not previously published will begin appearing on the BMS portal starting July 1, 2026. This means more rate transparency for providers going forward.
Frequently Asked Questions
Q: Where do I find the official West Virginia Medicaid fee schedule for 2026?
A: All 2026 fee schedules are posted at the BMS portal: bms.wv.gov/providers/west-virginia-medicaid-fee-schedules. Select your service category and download the 2026 PDF or Excel file. For managed care patients, log in to your MCO portal — such as The Health Plan — for plan-specific rates.
Q: Did West Virginia raise Medicaid reimbursement rates for mental health in 2026?
A: No. Senate Bill 994, which proposed Medicare-parity reimbursement for mental health services, was introduced in the 2026 session but did not pass. It was referred to committee in February 2026 and did not advance. No statutory mental health rate increase is in effect for 2026.
Q: What is the West Virginia Medicaid DME fee schedule effective date for 2026?
A: The 2026 DME Fee Schedule and DME Competitive Bidding Schedule are both effective April 1, 2026 through March 31, 2027. Both are available in PDF and Excel on the BMS DME Fee Schedule page. These files contain HCPCS code-level reimbursement amounts.
Q: What are the West Virginia Medicaid income limits for long-term care in 2026?
A: For nursing home (long-term care) Medicaid in West Virginia, the income limit is $2,982 per month for an individual. The asset limit is $2,000. A community spouse may retain up to $162,660 in joint assets. These are 2026 figures sourced from state eligibility guidelines.
Q: Does West Virginia Medicaid cover dental services in 2026?
A: Yes. West Virginia Medicaid includes a Dental Fee Schedule for 2026, which lists covered procedure codes and their reimbursement rates. The file is available on the BMS fee schedules portal. Coverage must also be confirmed in the applicable provider manual, as listing in the fee schedule alone does not guarantee coverage.
Q: What is the new SBHS provider expansion in West Virginia Medicaid for 2026?
A: Under SPA 26-0001, effective in 2026, three new provider types can now bill for School-Based Health Services: Board Certified Behavior Analysts (BCBAs), licensed Social Workers, and school counselors. The eligible student population has also expanded to include any Medicaid-enrolled youth with an IEP, IFSP, 504 Plan, or established medical necessity.
Sources & Disclaimer
Official Sources:
- West Virginia Bureau for Medical Services — Fee Schedules Portal: https://bms.wv.gov/providers/west-virginia-medicaid-fee-schedules
- BMS — Ensuring Access to Medicaid Services Final Rule Notice: https://bms.wv.gov/article/ensuring-access-medicaid-services-final-rule
- BMS — SPA 26-0001 SBHS Program Updates Public Notice: https://bms.wv.gov/public-notices/west-virginia-medicaid-program-spa-26-0001-regarding-sbhs-program-updates-and-expansion-eligible
- WV Medicaid Help — DoHS Community Engagement Info: https://wvmedicaidhelp.org
- The Health Plan Provider Fee Schedules: https://www.healthplan.org/providers/claims-support/fee-schedules
Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. For official eligibility determinations or provider rate verification, contact the West Virginia Bureau for Medical Services directly or visit Medicaid.gov.
Last Updated: June 2026
