Attention RI Medicaid Members: Update on Prescription Access Due to a cybersecurity issue, a contractor serving pharmacies and Medicaid programs across the US is unable to provide important online services at this time. In Rhode Island, this situation impacted pharmacies’ ability to fill prescriptions for members of the AIDS Drug Assistance Program (ADAP) and the Medicaid Program. In response, RI EOHHS has quickly brought online a new way for pharmacies to process claims. Rhode Island Medicaid has also told pharmacies that they can provide a 30-day supply of any prescriptions you are trying to fill, to help you get through this time. The pharmacy should not charge you for any prescription that is covered by Medicaid. Learn more.
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. 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. Eleanor Slater Hospital Rates 2019-Interim Proposed I/DD rates- effective 10/1/19 EOHHS responses to public comments regarding Independent Provider rates Home Stabilization - Emergency Case Management during COVID-19 Crisis National Correct Coding MUE Data DME Providers Outpatient Hospitals, Outpatient Psych, and Dialysis Ambulatory Surgical Centers and Professional Providers Outpatient Hospital Fee Schedules For the following items, visit the Hospital Provider Directory page APC Fee Schedule 2023 Updated October 2023 APC Fee Schedule 2022 APC Fee Schedule 2021 APC Status Codes Updated October 2023 Frequently Asked Questions Laboratory Procedure Codes Updated December 2023 Radiology Procedure Codes Updated December 2023 All Patient Refined Diagnosis Related Groups (APR-DRGs) RI DRG Calculator July 1, 2023 RI DRG Calculator (older versions) Frequently Asked Questions Ambulatory Surgical Center (ASC) Reimbursement Please visit the ASC page under the Provider Directories for more information. J Codes Requiring NDC J Code Conversion Table Updated November 2023 Users can print individual PDF by selecting the PDF and then indicating what page(s) to print.