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: Medicaid FFS Fee Schedule.