2026 Physician Fee Schedule Relative Value File (RVF) — CPT/Dental codes and rates
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This document is the West Virginia Bureau for Medical Services release of the 2026 National Physician Fee Schedule Relative Value File, providing CPT and dental code listings, status codes, descriptors, and transitioned facility/non-facility pricing fields for use in Medicaid reimbursement effective 04/01/2026 through 03/31/2027. It affects providers submitting claims to West Virginia BMS and staff who price or audit claims.
No material clinical or coverage changes in this revision.
Coverage criteria and fee-schedule coverage excerpts
Example coverage entries
Examples of coverage/coverage status per listed codes:
Anesthesia payment/coverage data (tabular)
Payment/coverage presentation for anesthesia codes
Anesthesia payment/billing criteria (excerpt)
Payment table indicators and placeholders for anesthesia services (partial).
Anesthesia reimbursement entries (partial)
Reimbursement table entries and indicators for anesthesia services (partial).
Anesthesia code payment entries (excerpt)
Reimbursement entries for anesthesia codes with associated attributes and amounts (excerpt).
Fee schedule entries (partial)
Coverage stance in this excerpt is limited to fee schedule entries for anesthesia code ranges; specific clinical coverage criteria are not present here.
Anesthesia fee schedule excerpt
Fee schedule/payment indicators for anesthesia HCPCS/HCPCS-T codes in this excerpt.
Anesthesia billing/coverage attributes (excerpt)
Reimbursement/billing attributes for anesthesia services by code range; numeric payment fields shown but predominantly zeroed in this excerpt.
Coverage stance in provided chunks
This portion of the document presents fee/status data and billing-related flags for anesthesia codes; it does not contain explicit medical-necessity coverage criteria in these chunks.
Coverage stance from fragment
No explicit positive/negative coverage decisions or medical necessity criteria are present in this fragment. The data are tabular attributes used for reimbursement calculations.
Partial anesthesia coverage/billing matrix
This partial section enumerates anesthesia procedure codes and associated billing attributes; numeric rates are shown as placeholders (0.00) in the provided text.
Not Covered procedures excerpt
Selected procedures explicitly labeled Not Covered in the table segment:
Audiometry and related services
Audiology-related T-codes and comprehensive audiometry entries:
Spine/implant procedures
Spine injection and implant procedures:
Coverage statements (excerpt)
Coverage stance for the listed Category III (T) CPT codes within this excerpt.
Per-code coverage excerpt
Per-code coverage determinations (excerpt):
Examples
- 0342T — Thxp apheresis w/ HDL delip: 2026 Status = Not Covered; Facility/Modifier fields present; payment cells shown as 0.00 in excerpt.
- 0345T — Transcatheter mitral valve repair: 2026 Status = Not Covered; Facility/Modifier fields present; payment cells shown as 0.00 in excerpt.
- 0347T — Insertion bone device for RSA: 2026 Status = Not Covered; payment/24.40 state fields show Not Covered/0.00.
Coverage summary for listed Category III codes
Per the excerpted fee table, many specific Category III CPT codes and their permutations (facility, mult bilateral, assistant, team, statewide) are designated as 'Not Covered' or have zero-dollar rates in this document section.
Code lists and pricing fields (CPT / HCPCS / T-codes)
| 00500-00620 (multiple individual CPT anesthesia codes shown) | Anesthesia procedure code ranges and individual codes referenced (examples: 00500, 00520, 00522, 00524, 00528, 00567, 00580, 00600, 00604, 00620) |
| 00567-0076T (partial range shown) | Anesthesia procedure codes appearing on these pages including cardiac, spine, abdominal, interventional procedures and special codes (examples include 00567, 00580, 00600, 00700, 00702, 0075T, 0076T) |
| 00844-00924 | Range of anesthesia procedure codes and descriptors appearing in this excerpt (individual code-level descriptions appear alongside ranges in the table) |
| 00920-00922 | Anes px male genitalia procedures (e.g., Anes px male genitalia nos; Anes px male genitalia vasec) — listed with anesthesia status and payment placeholders |
| 0101T | Esw muscskel sys nos (HCPCS 0101T) — 2026 Status = Status Code W Anesthesia |
| 0102T-01112 | Series of HCPCS-T sensory/anesthesia procedure codes (0102T through 01112 referenced) with 2026 status and billing attributes |
| 0108T–01442 (multiple specific anesthesia code ranges listed) | Anesthesia procedure code ranges and individual anesthesia codes with associated descriptors (examples include 0108T–01442 ranges referenced across chunks) |
| 01420-01522 | Lower-extremity anesthesia procedure clusters (knee, lower leg, ankle, foot procedures) as listed in chunks 144–156 |
| 01610-01712 | Shoulder/upper extremity anesthesia procedure clusters and related codes (chunks 157–163) |
| 01650 | Anesthesia procedure code listed with attributes |
| 01652 | Anesthesia procedure code listed with attributes |
| 01656 | Anesthesia procedure code listed with attributes |
| 0165T | Anesthesia procedure code listed with attributes |
| 01770 | Anesthesia procedure code listed with attributes |
| 01840 | Anesthesia procedure code listed with attributes |
| 01924 | Anesthesia/interventional radiology procedure code listed with attributes |
| 0198T | Ocular blood flow measure (temporary/Category/Anesthesia-related T-code) — listed with status/pricing fields |
| 01969 | Associated anesthesia-related code shown in table |
| 0214T | Njx paravert w/us cer/thor — Not Covered (2026 Status) |
| 0221T | Category III CPT code (listed in excerpt) — Not Covered |
| 0222T | Category III CPT code (listed in excerpt) — Not Covered |
| 0232T | Category III CPT code (listed in excerpt) — Not Covered |
| 0234T | Category III CPT code (listed in excerpt) — Not Covered |
| 0235T | Category III CPT code (listed in excerpt) — Not Covered |
| 0236T | Category III CPT code (listed in excerpt) — Not Covered |
| 0237T | Category III CPT code (listed in excerpt) — Not Covered |
| 0238T | Category III CPT code (listed in excerpt) — Not Covered |
| 0253T | Category III CPT code (listed in excerpt) — Not Covered |
| 0263T | Category III CPT code (listed in excerpt) — Not Covered |
| 0338T | Therapeutic apheresis w/HDL delip — Not Covered |
| 0339T | Therapeutic apheresis — Not Covered |
| 0342T | Therapeutic apheresis w/HDL delip — Not Covered |
| 0345T | Transcatheter mitral valve repair — Not Covered |
| 0347T | Insertion bone device for RSA — Not Covered |
| 0348T | RSA spine exam — Not Covered |
| 0349T | RSA upper extremity exam — Not Covered |
| 0350T | RSA lower extremity exam — Not Covered |
| 0351T | Intraop OCT breast/node specimen — Not Covered |
| 0352T | OCT breast/node incision & removal per spec — Not Covered |
| 0415T | Category III CPT code included in table (listed with facility/mult/asst/team/24.40 attributes) |
| 0416T | Category III CPT code included in table |
| 0417T | Category III CPT code included in table |
| 0418T | Category III CPT code included in table |
| 0419T | Category III CPT code included in table |
| 0420T | Category III CPT code included in table |
| 0422T | Category III CPT code included in table |
| 0437T | Category III CPT code included in table |
| 0439T | Category III CPT code included in table |
| 0440T | Category III CPT code included in table |
Billing, submission and denial-risk highlights
Status codes and claim handling notes
Status codes used in the RVF and how claims are handled for special statuses (e.g., Manual pended claims, Cost Invoice, CLFS, Unlisted code PA requirement).
- A = Active; B = Bundled; C = Carrier-Priced; T = Injections and other minor services.
- Manual = claims are pended for review and pricing; Cost Invoice = cost invoice must be submitted with claim for payment; CLFS = see Clinical Lab Fee Schedule.
- Unlisted/Manual codes require prior authorization and are reviewed and manually priced per BMS policy.
Anesthesia HCPCS payment / transition listing
Fee schedule rows list anesthesia HCPCS entries with modifier fields and transitioned facility/non-facility payment components (W, PE, MP, Total) and flags for Mult Bilat / Asst / Team.
- Payment components shown: W, PE, MP, Total for facility and non-facility transitioned entries.
- Modifier/attribute columns include Mult Bilat, Asst, Team and a 24.40 Statewide designation.
Anesthesia fee schedule excerpt (no PA rules in this section)
An excerpt of the anesthesia fee schedule lists multiple CPT anesthesia codes and code ranges (examples include 00500–00604 and many others) with payment placeholders and attribute indicators; this excerpt contains no prior authorization rules.
Anesthesia codes and descriptions (partial)
Partial listing of anesthesia procedure codes and short descriptions (e.g., anesthesia for direct CABG w/wo pump, heart/lung transplant, cervical spine procedures) shown with associated payment cells.
- Examples in the table: 'Anes direct cabg w/pump', 'Anes heart/lung transplant', 'Anes px crv spine & cord' linked to codes in the 00580–00604 range.
- Associated payment columns in the excerpt are predominantly 0.00 or placeholder values.
Fee schedule — modifiers and transition status (no PA instructions)
Fee schedule rows include specific HCPCS + modifier combinations and transition/status flags (Facility Transitioned, Mult Bilat, Asst, Team, 24.40 Statewide); no prior authorization instructions are present in this fragment.
- Modifier descriptions and transition columns are documented per HCPCS row (Facility Transitioned / Transitioned / Glob / Days / Proc fields).
- Mult, Asst, Team and 24.40 Statewide indicators are repeated across anesthesia entries; payment cells are shown but often 0.00.
Fee schedule excerpt — no authorization rules in this section
Anesthesia fee-schedule extract shows CPT/HCPCS-T codes with payment fields (many 0.00 or placeholders) and explicitly states there are no prior authorization or step therapy rules in these chunks.
- Example code groups (00844–00924) show Mult/Asst/Team indicator columns and 24.40 Statewide rows with rates often 0.00 or XXX placeholders.
- The excerpt does not provide authorization, denial risk, or step therapy instructions.
HCPCS‑T anesthesia entries and 2026 status
HCPCS-T anesthesia temporary/Category III entries (e.g., 0101T, 0102T, etc.) are listed with a 2026 status column (Status Code W / Anesthesia) and facility transition fields.
- 0101T is documented with '2026 Status = Status Code W Anesthesia' and Facility Transitioned / Mult Bilat / Asst / Team / 24.40 Statewide columns.
- Many HCPCS-T rows show payment values as 0.00 and include Mult Bilat and Asst flags (values such as N, D, XXX).
Anesthesia code range billing attributes
Anesthesia code ranges are presented with billing attributes including Mult Bilat, Asst, Team and numeric payment entries (often zeroed); prior authorization requirements are not specified here.
- Code ranges (e.g., 0108T–01442, 01620–01630) include Mult Bilat / Asst / Team indicator values (N, D, XXX) and 24.40 Statewide columns.
- Numerous payment cells across these ranges are shown as 0.00 or placeholders.
HCPCS modifiers and facility transition notes
HCPCS modifier and facility transition table notes: each HCPCS row includes Modifier Description, 2026 Status (often 'Anesthesia' or 'Status Code W'), Facility Transitioned values and columns for Mult, Asst, Team and 24.40 Statewide.
- Columns shown: 2026 Status, Facility Transitioned (W / PE / MP / Total), Mult (Mult Bilat), Asst (Asst Co‑Surg), Team (Team Surg Facility), and 24.40 Statewide.
- Entries repeatedly show 0.00 for payment cells with modifier flags present.
Procedure attributes listing (no PA rules in fragment)
Procedure-attribute rows list anesthesia codes with attributes (2026 status, facility transition, multiplicity, assistant, team, statewide adjustment) but do not include prior authorization or documentation workflow in this fragment.
- Attributes present per code: 2026 Status, Facility Transitioned values, Mult, Asst, Team, and 24.40 Statewide.
- No PA, denial-risk workflow, or documentation requirements are specified in these listings.
Anesthesia code billing attributes (partial)
HCPCS/CPT anesthesia code billing attributes (partial) are shown: status, facility transition, multipliers, assistant/team indicators and statewide factor entries are present for individual codes with many payment cells 0.00.
- Examples include 01952–01958 and other codes with 2026 Status and Facility Transitioned rows and Mult/Asst/Team flags.
- Statewide factor '24.40' appears across multiple groups; numeric payment fields are predominantly 0.00.
Coverage denial indicators (Not Covered labels)
Certain listed procedures and specific Category III (T) codes are explicitly labeled 'Not Covered' in the fee table; claims for these codes will not be reimbursed per the excerpt.
- Examples marked Not Covered: percutaneous sacral augmentation unilateral and bilateral (01999/0200T), multiple Category III codes (e.g., 0222T, 0232T, 0342T, 0345T, 0347T, 0348T, 0349T).
- For codes marked 'Not Covered', the 24.40 Statewide and Facility Transitioned cells commonly show 'Not Covered' and 0.00.
Audiometry and related T‑codes marked Not Covered
Multiple audiometry and related temporary (T) codes (e.g., 0207T–0209T) are listed as 'Not Covered' in the fee schedule; the table shows 'Not Covered' with corresponding 0.00 payment fields.
Coverage status listing and facility transition indicators for Category III (T) codes
Category III (T) CPT codes in the excerpt include a coverage status column and facility transition indicators; many of these T‑codes are designated as 'Not Covered' with corresponding modifier/attribute columns documented.
Coverage / billing actions for listed Category III codes (no PA info in excerpt)
Coverage and billing actions for listed Category III codes are documented in the table (including 'Not Covered' determinations and modifier handling); the excerpt does not include prior authorization or documentation workflows for these codes.
- Per‑code rows show 2026 Status and Facility/24.40 Statewide treatment; many codes report 'Not Covered' with 0.00 payments.
- Modifier columns (Mult Bilat, Asst, Team) and facility/non‑facility splits are included for each code row; no PA instructions are provided in these fragments.
Coverage listings (no authorization instructions in excerpt)
The coverage listings excerpt documents coverage status (including numerous 'Not Covered' entries) for specific Category III CPT codes and variations; it contains no prior authorization or documentation instructions in this section.
- Rows for codes in the 0415T–0472T range show 24.40 Statewide and modifier flags, with many entries labeled 'Not Covered' and 0.00.
- The excerpt is a fee/status extract and does not specify PA or clinical documentation requirements for these entries.
Key terms and table-field definitions
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