West Virginia Medicaid Physician's Fee Schedules

​​​Acute Care Hospitals Inpatient Prospective Payment System (IPPS), also known as the DRG calculator) Update!

The Office of Accountability and Management Reporting (OAMR), in its responsibility of Rate Setting and Provider Reimbursement for the Bureau for Medical Services (BMS), has changed the timeline of updating the base amount for all acute care hospitals for inpatient care. In an effort to streamline the process, there will now be only one update. On October 1, 2018, instead of two as in previous years. The July 1st base amount update will now coincide with the October 1st update of DRG weights. If you have any questions, please contact Leigh Ann Moore (OAMR) at 304-356-4916.

Fee Schedule Updates

The following fee schedules will now be effective April 1st through March 31st starting in calendar year (CY) 2019:

  • Physician's (RBRVS) Fee Schedule
  • Clinical Lab Fee Schedule
  • Durable Medical Services
  • Home Health Agencies
  • Ambulatory Surgical Centers

Disclaimer: Note that the absence or presence of a reimbursement code and its associated allowance on these pages does not guarantee Medicaid coverage of the item or procedure. Please refer to the appropriate West Virginia Medicaid provider manual for coverage determination.

Ambulance Fee Schedule
Ambulatory Surgery Center Rates
Applied Behavior Analysis Fee Schedule​
Dental Fee Schedule
DRG Weights Updates
Drug-Free Mom and ​Baby (DFMB) Fee Schedule
Emergency Department Fee Schedule
Hospice County Rates
Hospital OP Surgery Max Units
Licensed Beha​vioral Health Center Fee Schedule 
Archive Fee Schedules

Waiver Program Rates

Aged and Disabled Waiver (ADW) Rates
Children with Serious Emotional Disorder Waiver (CSEDW)
Intellectual/Developmental Disabilities​ Waiver (IDDW)
Traumatic Brain Injury Waiver (TBIW)




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