Starting February 7, 2008 - All Files are Updated 3 Times a Week (Mon, Wed, Fri)
The DMAS Procedure Fee Files contain the rate history for procedure codes and associated program and claim processing information. DMAS will update the files three times per week, Monday, Wednesday, and Friday..
The DMAS Procedure Fee File is posted in three separate files: Medical, Dental, and Revenue. For easier downloading and due to the size of the Medical file, the Medical file is further separated into four parts. The range of codes is listed for each part.
The Procedure Rate File Layout in pdf format describes each file’s data structure as well as provides values for certain fields. The file layout lists fields in the order that the fields occur in the file. The rates listed on the fee files may be the same as or different from those paid to providers as some providers enrolled with Virginia Medicaid are paid a percentage of the total rate listed.To download a file directly to your PC, put your cursor over the selected file name and click the right mouse button. Next, left mouse click on "Save Target As..." from the options box provided. A “Save As” window will open and you can select where to save the file on your PC. For ease of viewing, downloading the files and opening in excel or other software is recommended. If you click “Open” the file will open in the existing window or new window using the software available on your PC. All of the functions of excel to view the file will not be available. Opening or downloading files may take up to several minutes depending on the speed of internet access. Do not click more than once as it will slow the download.
Fee Schedule for Emergency Air or Ground transportation
Downloads Available
Comma Separated Value (csv) Format or Text (txt) Format
- Medical
HCPC Codes – Durable Medical Equipment, Injectibles, Supplies, Etc.(CSV) Format
- Medical Fee File - HCPCS (csv)
(TXT) Format
- Medical Fee File - HCPCS (txt, comma delimited data file)
CPT Codes – Medical Procedures Billed by Physicians or Other Practitioners.
Effective July 1, 2008 - The procedure fee file will reflect facility rates for certain CPT codes. The field INP_OUT will contain the values “IP” and “OP”. The place of service submitted on the claim as well as the type of provider billing will determine whether the procedure receives a facility (IP) rate or a non-facility (OP) rate. The place of service codes that are considered facility (IP) based services are: 21, 22, 23, 24, 31, 51, 53, and 61. All others are considered to be non-facility (OP) based services. Further information on this topic is available in the Physician Rate Changes Medicaid Memo dated May 28, 2008.
To all users of DMAS's Medical CPT Codes for Medical Fee Files - CPT files the fields for Anesthesia Base Units have been expanded in both the CSV and TXT formats to now be a 5 position field to include a one-position decimal place. This field was previously a 4 position field, i.e., 0004, and now is a 5 position field, i.e., 004.0. Please be aware of this when downloading the files for your use.
(CSV) Format
- Medical Fee File - CPT Part 1 (csv) contains CPT Codes 0001F - 29999
- Medical Fee File - CPT Part 2 (csv) contains CPT Codes 3000F - 49999
- Medical Fee File - CPT Part 3 (csv) contains CPT Codes 50010 - 79999
- Medical Fee File - CPT Part 4 (csv) contains CPT Codes 80002 – 99602
(TXT) Format
- Medical Fee File - CPT Part 1 (txt) contains CPT Codes 0001F - 29999
- Medical Fee File - CPT Part 2 (txt) contains CPT Codes 3000F - 49999
- Medical Fee File - CPT Part 3 (txt) contains CPT Codes 50010 - 79999
- Medical Fee File - CPT Part 4 (txt) contains CPT Codes 80002 – 99602
- Dental - Dental Procedures
(CSV) Format
- Dental Fee File - (csv )
(TXT) Format
- Dental Fee File - (txt, comma delimited data file)
- Revenue – Revenue Codes for Home Health, Hospice, or Other Services
(CSV) Format
- Revenue Fee File - (csv )
(TXT) Format
- Revenue Fee File - (txt, comma delimited data file)
The most commonly used fields are listed below. Please note that the Procedure Rate file is historical and fields identifying the effective and end dates should be used to match the date of service with the rate.
PROC CODE Procedure Code CPT/HCPC/Revenue Code PROC TYPE Procedure Type Medical/Dental/Revenue CAT TYPE Category AGE/REG/WAV – May have different rates for each CAT DESC MAX RATE Max (Effective) Rate Global rate for the effective and end date ranges EFF DATE Rate Effective Date Date rate began END DATE Rate End Date Date rate ended or default value of 12/31/9999 for current rate PC RATE Professional Component Rate Component rate for the PC effective and end date ranges TC RATE Technical Component Rate Component rate for the TC effective and end date ranges ANES Anesthesiology Base Units Base units for anesthesia procedures FLAG CDE Flag Codes Codes that identify specific procedure, program and claims processing information PA_TYPE Prior Authorization (PA) Type Values identify level of PA required Formatting Issues (Opening/Importing Files in Excel or Other Software)
You may choose to define the columns with fee amounts either as dollar or number fields in order to see the decimal places. You will need to define the procedure-code fields as text or else leading zeroes will be dropped. Also, each file has a header record identifying the data in each column. Please refer to your own software manual or the Help function in your software packages for further instructions on opening, importing, saving, and/or resizing files.
Frequently Asked Questions (FAQs):
Q: How do I know what information is on the Procedure Fee File?
A: The Procedure Fee File contains the rates and other rate related information by procedure and revenue code. The Procedure Rate File Layout (pdf) is a list of the fields and data values of the information on the fee file.Q: What file should I access, csv or txt?
A: Depending on the software available on your PC, the user may easily use the csv or txt format. Both formats contain the same data. The DMAS Procedure Fee File instructions note which type of file is available to download.Suggestion:The txt version is recommended for users who wish to download this document into a database application. The csv version opens easily in an Excel spreadsheet file.
Q: How long will it take to download?
A: Download time is determined by the size of the file and the internet connection. If downloading via a dial-up connection by phone line it may take 30 minutes or more. High-speed internet and broadband connections are much faster.Q: Will the Procedure Fee File tell me if a procedure needs to be prior authorized?
A: Yes, it will identify a numeric value for the field PA_TYPE, one of the following:
- 00 No PA required
- 01 Always needs a PA
- 02 Only needs PA if service limits are exceeded
- 03 Always needs PA, with per frequency
