Virginia Medicaid Other Services Fee Schedule 2026

Virginia Medicaid publishes 327 other services procedure rates effective 2026, paying a median 59.8% of the national Medicare amount for the same services. This page shows published rates for common other services procedures with plain-language descriptions and, where a comparator exists, each rate as a percentage of national Medicare.

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The table on this page is a common-procedure sample. The full Virginia other services schedule has 327 codes.

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Published codes

327

Other Services procedures on the 2026 schedule

Median % of Medicare

59.8%

vs national Medicare, GPCI-neutral

Effective vintage

2026

latest effective year on the schedule

Common other services procedures and what Virginia Medicaid pays

A curated sample of recognizable procedures from the 327-code schedule. Rates are the state's published fee-for-service amounts; the percentage compares each rate with the national Medicare amount for the same code.

CodeProcedureVirginia rate% of Medicare
S5125Attendant care services; per 15 minutes$1.18--
T1015Clinic visit/encounter, all-inclusive$6.12--
T1019Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant)$23.81--
T2021Day habilitation, waiver; per 15 minutes$52.12--

Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * show the schedule's representative published variant.

More Virginia Medicaid fee schedules

Other Services rates in neighboring states

Frequently asked questions

What does Virginia Medicaid pay for other covered services?

Virginia Medicaid publishes 327 other services procedure rates effective 2026, paying a median 59.8% of the national Medicare amount for the same services. The schedule covers clinic encounters, screenings, and state-specific service codes. The table on this page shows published rates for common procedures; the complete all-codes schedule is available as a CSV download with a ProviderSignal Rates subscription.

How do Virginia's other services rates compare with Medicare?

Across other services codes with a national Medicare comparator, Virginia Medicaid pays a median 59.8% of the Medicare amount (GPCI-neutral national comparison). Individual codes vary widely, so check the per-code percentage in the table.

Do other services services need prior authorization in Virginia?

Virginia does not publish prior-authorization indicators on this fee schedule, so PA requirements must be confirmed through the state's provider manual or portal. Absence of a flag here means "not published", never "no PA required".

Where do these rates come from?

Directly from Virginia's published Medicaid fee-for-service schedule (effective 2026), collected and normalized by ProviderSignal across all 50 states + DC. Rates are re-collected on a rolling schedule and this page updates automatically. Procedure descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.

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