The Rates plan
$29/mo7-day free trialThe table on this page is a common-procedure sample. The full Vermont physician schedule has 6,514 codes.
- Every code on all 51 published schedules
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Published codes
6,514
Physician procedures on the 2026 schedule
Median % of Medicare
81.3%
vs national Medicare, GPCI-neutral
PA required
163
codes flagged by the state
Common physician procedures and what Vermont Medicaid pays
A curated sample of recognizable procedures from the 6,514-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.
| Code | Procedure | Vermont rate | % of Medicare |
|---|---|---|---|
| 10021 | Fine needle aspiration biopsy, first lesion, no imaging | $83.80 | 83.1% |
| 10060 | Drainage of a skin abscess, simple | $107.14 | 83.3% |
| 10061 | Drainage of a skin abscess, complicated or multiple | $181.88 | 82.6% |
| 10120 | Removal of a foreign body from tissue, simple | $131.35 | 83.5% |
| 10140 | Drainage of a blood or fluid collection under the skin | $144.80 | 83.1% |
| 11042 | Wound debridement, skin and tissue below, first 20 sq cm | $110.83 | 83.6% |
| 11043 | Wound debridement to muscle, first 20 sq cm | $197.33 | 82.4% |
| 11044 | Wound debridement to bone, first 20 sq cm | $262.73 | 81.9% |
| 11102 | Skin biopsy, tangential, first lesion | $80.11 | 83.9% |
| 11104 | Skin biopsy, punch, first lesion | $101.49 | 83.7% |
| 11106 | Skin biopsy, incisional, first lesion | $126.55 | 83.6% |
| 11200 | Removal of skin tags, up to 15 | $76.99 | 83.5% |
| 11300 | Shave removal of a skin lesion, trunk/arm/leg, 0.5 cm or less | $80.96 | 83.9% |
| 11305 | Shave removal of a skin lesion, scalp/neck/genitals, 0.5 cm or less | $84.78 | 83.8% |
| 11400 | Removal of a benign skin growth, trunk/arm/leg, 0.5 cm or less | $106.87 | 83.5% |
| 11402 | Removal of a benign skin growth, trunk/arm/leg, 1.1-2 cm | $142.40 | 83.3% |
| 11720 | Trimming of thickened nails, 1-5 | $27.31 | 83.4% |
| 11721 | Trimming of thickened nails, 6 or more | $37.50 | 83.2% |
| 11730 | Removal of a nail plate, partial or complete | $93.40 | 83.7% |
| 11750 | Permanent removal of part or all of a nail | $131.62 | 83.5% |
| 11976 | Removal of a contraceptive implant | $120.05 | 81.9% |
| 11981 | Insertion of a medication-releasing implant | $88.20 | 82% |
| 12001 | Simple wound repair, scalp/trunk/limbs, 2.5 cm or less | $94.30 | 82.8% |
| 12002 | Simple wound repair, scalp/trunk/limbs, 2.6-7.5 cm | $114.68 | 82.3% |
| 12011 | Simple wound repair, face/ears/lips, 2.5 cm or less | $115.11 | 82.5% |
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
- Vermont dme & supplies fee schedule · 1,914 codes
- Vermont lab & imaging fee schedule · 1,880 codes
- Vermont drugs fee schedule · 746 codes
- Vermont anesthesia fee schedule · 274 codes
- Vermont other services fee schedule · 271 codes
- Vermont vision fee schedule · 150 codes
Physician rates in neighboring states
Frequently asked questions
What does Vermont Medicaid pay for physician and professional services?
Vermont Medicaid publishes 6,514 physician procedure rates effective 2026, paying a median 81.3% of the national Medicare amount for the same services. The schedule covers office visits, preventive care, surgery, and evaluation and management services. 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 physician rates compare with Medicare?
Across physician codes with a national Medicare comparator, Vermont Medicaid pays a median 81.3% of the Medicare amount (GPCI-neutral national comparison). Individual codes vary widely, so check the per-code percentage in the table.
Do physician services need prior authorization in Vermont?
Vermont publishes prior-authorization flags on its schedule: 163 physician 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.
Get an email the next time Vermont changes these rates.