Fee Schedules

Pediatric Physician Rate Increase

RI Medicaid has implemented a rate increase to allow physicians billing for recipients under the age of 21 years to receive rates equivalent to Medicare. This rate increase will be retro-actively effective for dates of service on or after July 1, 2022. Providers should update their billing systems to reflect the new rates in order to be reimbursed correctly.
The new rates can be viewed on the bottom of the Physician Directory page.

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.
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.