Medicaid Provider Information

Find provider information including forms, program updates, and fee schedules on this page.

Security Incident Updates

Medicaid Coronavirus Disease 2019 (COVID-19) Updates

During this rapidly evolving situation, we will provide updates as they become available. All Medicaid Providers should check the Medicaid COVID-19 Provider Updates page often. For general coronavirus information, visit coronavirus.maryland.gov.

COVID-19 Fee Schedules

Public Notice

Maryland's State Plan Amendment for Excluded Weight Loss Drugs Clarification - November 16, 2022
Residential Treatment Center Rate Rebasing - October 20, 2022
DDA TCM Temporary Rate Increase - September 27, 2022
Fiscal Year 2023 Brain Injury Waiver - September 27, 2022
Maryland's State Plan Amendment for Coverage of the Administration of Monkeypox Vaccinations -- July 29, 2022
Maryland's State Plan Amendment for Coverage of the Administration of COVID-19 Testing and Treatment -- July 6, 2022
Fiscal Year 2023 Provider Rate Increases -- June 28, 2022
Maryland Medicaid Disposable Medical Supplies and Durable Medical Equipment Fee Rate Changes -- June 22, 2022
Correction: Public Notice for Medicaid Provider Rate Changes Beginning 11/1/21 -- November 23, 2021
Public Notice for Medicaid Provider Rate Changes Beginning 11/1/21 -- October 28, 2021
Public Notice for FY 2022 Medicaid Nursing Facility Rates -- August 17, 2021
Revised Public Notice for FY 2022 Medicaid Nursing Facility Rates -- July 30, 2021
Public Notice for FY 2022 Medicaid Nursing Facility Rates -- June 30, 2021
Public Notice for Residential Treatment Centers Rate Rebasing-- June 16, 2021
Public Notice for Maryland Medicaid Medication Assisted Treatment SPA-- February 10, 2021
Second Public Notice for Maryland Medicaid Enteral Nutritional Services Reimbursement-- January 15, 2021
Second Public Notice for Maryland Medicaid Enteral Supplies Reimbursement-- January 15, 2021
Maryland Medicaid DMS/DME and Oxygen Rate Adjustment- Revised Effective Date -- Decemember 22, 2020
Maryland Medicaid Provider Rate Changes from January 1, 2021-- December 18, 2020
Coverage of the Administration of COVID-19 Vaccines -- December 17, 2020
Board of Public Works Medicaid Provider Rate Changes for DC Hospitals -- July 14, 2020
Board of Public Works Provider Rate (State Plan) Updates across the Maryland Medical Assistance Program -- July 1, 2020

RECENT UPDATES

ePREP is Live! Click here for more information.

Information for Pharmacist Prescribers
New Service! Remote Patient Monitoring
Information for Attending, Ordering, Referring, and Prescribing (ORP) Providers *NEWLY UPDATED*

PROVIDER ENROLLMENT INFORMATION

Maryland Medicaid Provider Enrollment Portal, ePREP. Click here for more information

Provider Application Addenda and Agreement Forms. Select the addendum specific to your provider type.
Private Daily Room Rate Change Form
Provider Verfication System (PVS) - NEW! CLICK HERE TO VERIFY A PROVIDER'S ENROLLMENT STATUS
PVS Overview for Providers - How to verify provider enrollment status

AUDIOLOGY SERVICES INFORMATION

Audiology, Physical Therapy, and Early Periodic, Screening, Diagnosis and Treatment (EPSDT) Provider Manual Effective January 1, 2022
Audiology Clinical Criteria Effective October 1, 2020
Audiology Provider Memo April 2019
Audiology Corrections Memo December 2018
Audiology MCO Preauthorization Contacts List 2019
Audiology Parent Q & A English
Audiology Parent Q & A Spanish

BEHAVIORAL HEALTH INFORMATION

Announcing: Optum Maryland will be the new Behavioral Health Administrative Service Organization (ASO). Effective January 1, 2020.

In the interim, Behavioral Health services must be authorized by the Department's designated Administrative Service Organization, Beacon Health Options.

BILLING GUIDANCE, FEE SCHEDULES, and PREAUTHORIZATION INFORMATION

Nursing Services Program Rates – Fiscal Year 2020 Effective 7/1/19
COVID-19 Reimbursable Vaccine and Infusion Codes Fee Schedule
Monkeypox Vaccine and Administration Fee Schedule
Professional Services Preauthorization Information New Effective 1/1/19
2022 Professional Services Fee Schedule New Effective 1/1/22 Updated 10/31/22
2021 Professional Services Fee Schedule New Effective 11/10/21
2022 Professional Services Provider Manual Effective 1/1/22
Certification For Abortion - MDH 521
Document for Hysterectomy- MDH 2990
Sterilization Consent Form - HHS-687
Sterilization Consent Form (Spanish) -HHS 687-1
CMS 1500 Billing Instructions Updated 6/23/22
- CMS 1500 Claims Training Webinar Presentation (slides)
- CMS 1500 Claims Training Webinar (recording)
Time Limits - Submitting Invoices
Medicare Advantage Plan Cost Sharing Memorandum
Medicare Advantage Plan Billing Instructions for UB04
Medicare Advantage Plan Billing Instructions for CMS-1500
Billing Instructions for ADAA Certified Addictions Outpatient Program Providers
Private Duty Nursing/Home Health Aide Fee Schedule
School-Based Health Center Provider Manual Updated August 2021
Podiatry Services Provider Manual Revised April 2019
New!UB04 'Cheat Sheet' for ICD-10
2020 UB04 Billing Guidance for Institutional Providers Updated April 23, 2020
Environmental Lead Inspection Fee Schedule
HIV Case Management Fee Schedule
New!Adjustment Request Form 4567
New!Adjustment Request Form 4518A
Urgent Care Facility Guidelines

CREDIBLE ALLEGATION OF FRAUD

DENTAL and LABORATORY INFORMATION

Medical Laboratory Fee Schedule 2022 (PDF) Effective March 1, 2022 updated 9/1/2022
Medical Laboratory Fee Schedule 2022 (Excel) Effective March 1, 2022 updated 9/1/2022
Medical Laboratory Fee Schedule 2021 (PDF) Effective February 1, 2021
Medical Laboratory Fee Schedule 2021 (Excel) Effective February 1, 2021
Medical Laboratory Fee Schedule 2020 (PDF) Effective March 1, 2020 update 12/16/2020
Medical Laboratory Fee Schedule 2020 (Excel) Effective March 1, 2020 update 12/16/2020
COVID-19 Reimbursable Laboratory Codes Fee Schedule
Laboratory Preauthorization Decision Procedure
2022 Dental Fee Schedule and Procedure Codes Effective July 1, 2022
2022 Dental Fee Schedule and Procedure Codes Effective January 1, 2022
2019 Dental Fee Schedule and Procedure Codes Effective January 1, 2019
2020 Dental Fee Schedule and Procedure Codes Effective January 1, 2020
2021 Dental Fee Schedule and Procedure Codes Effective January 1, 2021
2019 Adult Dental Pilot Fee Schedule and Procedure Codes Effective June 1, 2019

ELIGIBILITY VERIFICATION SYSTEMS (EVS) INFORMATION

EVS is a system available to allow verification of Maryland Medicaid recipient eligibility status. DHMH has a few EVS applications:

IVR - Telephone inquiry/response system: EVS IVR User Guide
WebEVS - Web-based EVS application available for provider's with access to eMedicaid

eMEDICAID

eMedicaid is a secure online service for Maryland Medicaid Providers where you can verify recipient eligibility, obtain payment information and Remittance Advice (RA).