Fee Schedules

Pediatric Physician Rates

In accordance with Article 12 of the SFY2023 Budget, EOHHS implemented a minimum fee schedule for pediatric primary care, aligning rates with Medicare. Each year, on July 1, EOHHS updates the Medicaid fee-for-service (FFS) schedule based on the most recent geographically adjusted Medicare professional fee schedule. For services not covered by Medicare, EOHHS calculates an equivalent rate using the relevant RVU and geographic practice cost adjustment factors.

Typically, CMS updates professional service rates in January but may issue revisions throughout the year. If CMS revises rates before the start of the state fiscal year, EOHHS will use those revisions for the July 1 Medicaid FFS fee schedule update. However, no mid-year adjustments will be made if CMS issues revisions after July 1.

For the latest rates, please refer to the Medicaid FFS interactive fee schedule below.

Below are the links to the Medicaid Fee Schedules.

Interactive Fee for Service Fee Schedule

Interactive Outpatient Pricing Fee Schedule (NOT APC Pricing)*

* NOTE: This is NOT the APC Fee Schedule/See Outpatient Hospital Fee Schedules for APC Fee Schedule.

Please Note:

There are circumstances that may impact pricing such as: manual pricing, provider-specific certification/pricing, or multiple surgical procedure codes.
- Please see more specific information on the Provider Type page.
- For Home Care Providers please see the home care/personal care page.
When the rate is listed as $0, then the claim is priced manually and requires supporting documentation.
Pricing Action Code (PAC) values are:
- Blank - Base Medicaid
- I - Informational
- M - Manual
- P - Percentage
- S - Special modifier pricing
Fee schedule information will be updated to the web on a weekly basis.
Fee schedule data will span the last three years.
For additional information or questions, please contact the Customer Service Help Desk at 401-784-8100.