Vermont Medicaid State-Specific Services Fee Schedule 2026

Vermont Medicaid publishes 271 state-specific and temporary HCPCS code rates effective 2026, paying a median 83.8% of the national Medicare amount for the same services. This page lists the Q, S, T and C codes Vermont prices outside its standard categories, with plain-language descriptions and, where a comparator exists, each rate as a percentage of national Medicare. It is one category of the Vermont Medicaid fee schedule (10 categories).

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The table on this page is a common-procedure sample. The full Vermont state-specific services schedule has 271 codes.

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Published codes

271

state-specific and temporary HCPCS codes on the 2026 schedule

Median % of Medicare

83.8%

vs national Medicare, GPCI-neutral

PA required

41

codes flagged by the state

Common state-specific and temporary HCPCS codes and what Vermont Medicaid pays

A curated sample of recognizable procedures from the 271-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.

CodeProcedureVermont rate% of Medicare
S5125Attendant care services; per 15 minutes$12.50--
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)$12.98--

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 Vermont Medicaid fee schedules

State-Specific Services rates in neighboring states

Frequently asked questions

What does Vermont Medicaid pay for state-specific and temporary HCPCS services?

Vermont Medicaid publishes 271 state-specific and temporary HCPCS code rates effective 2026, paying a median 83.8% of the national Medicare amount for the same services. The schedule covers clinic and screening encounters, telehealth facility fees, personal care, and other C, Q, S and T 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 Vermont's state-specific services rates compare with Medicare?

Across state-specific services codes with a national Medicare comparator, Vermont Medicaid pays a median 83.8% of the Medicare amount (GPCI-neutral national comparison). Individual codes vary widely, so check the per-code percentage in the table.

Do state-specific and temporary HCPCS services need prior authorization in Vermont?

Vermont publishes prior-authorization flags on its schedule: 41 state-specific services codes are marked as always requiring PA. Codes without a flag carry no published PA indicator.

Where do these rates come from?

Directly from Vermont'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.