West Virginia Medicaid pays $65.15 for code 99213, the standard return office visit, ranking 29th of 46 states against a national median of $75.27. That middle-of-the-table position holds across almost every physician code, and most of them took effect on the same date, 2026-04-01. The Bureau for Medical Services (BMS) publishes its main schedules on an April-to-March cycle, with the current set running from 4/1/26 to 3/31/27.
The outliers are in disability services. West Virginia's behavior technician rate is the lowest of 42 states, and its IDD in-home support rate is 28th of 29. MedicaidRate holds all 88,707 current West Virginia rates from 62 official source documents across 6 programs, with history back to 2017. Each rate links to its BMS source document.
BMS publishes its fee-for-service rates as a set of annual schedules:
- BMS RBRVS 2026, effective 4/1/26 - 3/31/27, for physician and practitioner services.
- 2026 ASC Fee Schedule, ASC rates effective 04/01/26 - 03/31/27 (REV 10.1.2026).
- BMS DME 2026 Rural and Non-Rural Fee Schedules, effective 4/1/26 - 3/31/27.
- BMS Anesthesia, Dental and Home Health Agencies schedules on the same April cycle.
- CY 2026 Surgery Max Units list and the BMS Physician Administered Drug ASP Pricing File.
- Nursing Facility Fee Schedule, effective 7/1/26 - 12/31/2026.
- In State and Out of State DRG Calculators for inpatient stays.
- BMS CY 2023 Clinical Lab Fee Schedule.
Hospital outpatient is by far the largest service line, with 57,450 of the state's rates, ahead of physician services at 14,053.
The programs: West Virginia Medicaid fee-for-service under BMS (88,546 rates), School-Based Health Services (71), and four 1915(c) waivers: Intellectual/Developmental Disabilities (IDDW, 59), Children with Serious Emotional Disorder (CSEDW, 11), Aged and Disabled (ADW, 10) and Traumatic Brain Injury (TBIW, 10).
Waiver services are paid directly by the state, outside managed care, so the waiver rate is what an agency receives. Because the IDDW carries most of the waiver rates, its pricing drives the economics for disability service providers in the state.
BMS builds its physician schedule on RBRVS, the relative value system Medicare uses. Each code's relative value is multiplied by a state conversion factor to produce a dollar rate. That is why West Virginia's E/M codes move together: a change in the conversion factor shifts the whole ladder at once, keeping relative rankings stable.
Rural and non-rural DME
West Virginia prices DME separately for rural and non-rural settings. Suppliers should confirm which schedule applies to each delivery location, since the same item can carry a different rate.
Units and modifiers
Visits are paid per service; ABA, personal care, nursing and most behavioral health codes per 15-minute unit. Modifiers define the provider level and program: behavior technician work under H2014 uses modifier U5, IDD supports under S5125 use U8, and personal care under S5125 uses UB.
| Code | What it is | WV rate | Rank | National median |
|---|---|---|---|---|
| 99213 | Return visit, level 3 | $65.15 | 29 of 46 | $75.27 |
| 99214 | Return visit, level 4 | $93.21 | 31 of 46 | $108.69 |
| 90837 | Psychotherapy, one hour | $116.39 | 31 of 48 | $132.38 |
| 97153 | ABA by a technician, 15 min | $9.90 | 41 of 42 | $15.86 |
| T1019 | Personal care, 15 min | $6.75 | 23 of 39 | $7.07 |
| A0427 | Ambulance, advanced life support | $505.82 | 10 of 44 | $387.24 |
Physician rates are consistent
Every E/M code from 99203 ($81.25) to 99215 ($132.49) ranks between 29th and 31st of 46, and all took effect 2026-04-01. Medicare pays $90.10 for 99213 in West Virginia.
Behavioral health is in the same band
Psychotherapy codes 90837 and 90834 ($79.54) and assessment code 90791 ($120.78) rank 31st to 32nd, all on the BMS fee-for-service schedule from 2026-04-01. H2019 pays $10.40 per 15 minutes, 27th of 35, and H0031 pays $151.20 per encounter.
Ambulance is a bright spot
A0427 at $505.82 ranks 10th, well above the median. Ambulance services are paid directly by the state, so this is the rate providers receive.
West Virginia ABA rates split sharply by provider level. The behavior technician code H2014 with modifier U5 pays $2.50 per 15 minutes, $10.00 an hour, last of 42 states and 84.2% below the national median. CPT code 97153 pays $39.60 an hour, 41st. Both have held since 2019 and 2021.
Analyst code 97155 is different: at $29.14 per 15 minutes ($116.56 an hour) it ranks 17th of 41 and sits above the $25.10 median. For an ABA provider, the gap between technician pay and analyst pay is the defining feature of this schedule. A program built on technician hours will struggle to cover wages at these rates; one with a higher share of analyst-delivered treatment can operate closer to the national middle.
- West Virginia IDD supports: S5125 with modifier U8 pays $3.38 per 15 minutes, $13.52 an hour, 28th of 29 and 61.3% below the median.
- West Virginia personal care: S5125 with modifier UB pays $6.75 per 15 minutes, $27.00 an hour, 18th of 27 and 11.5% below the median. T1019 pays the same $6.75.
- West Virginia private duty nursing: T1000 at $44.08 an hour, 29th of 43 and 19.6% below the median.
- Physical therapy under 97110 pays $79.04 an hour, 40th of 49.
- Nursing facilities: $436.57 a day under CBC1 from 2026-07-01. Hospice: $187.58 a day under revenue code 651.
Five MCOs are named: Aetna Better Health of West Virginia, Highmark Health Options West Virginia, The Health Plan of West Virginia, UniCare Health Plan of West Virginia and Wellpoint West Virginia.
Of 21 service lines classified, the published rate binds plans on 10:
- Plans negotiate; the published rate applies out of network for hospital outpatient and inpatient, physician services, radiology, laboratory, pharmacy, dental, home health, hospice and vision.
- Plans must pay at least the published rate for DME and supplies and for behavioral health.
- The state sets the rate plans pay for FQHC, RHC and clinic services.
- Paid directly by the state, outside managed care for nursing facilities, IDD services, therapy, personal care, private duty nursing, HCBS and transportation.
Our current West Virginia data lists no active directed payment programs. The West Virginia managed care page lists every line.
For therapists, personal care agencies and IDD providers, the direct-pay rule means the BMS rate is the rate paid; there is no plan to negotiate with. Budget from the published schedule and track BMS letters for changes.
Behavioral health providers have a floor: no MCO can pay below the BMS rate. Because that rate sits around 31st nationally, the floor is modest, and negotiation should aim above it. Physician practices and hospitals are on negotiated terms, with the BMS rate as the out-of-network reference. Given that the E/M ladder sits below Medicare, Medicare is the stronger anchor in contract talks.
- HCBS and personal care: a BMS letter dated October 10, 2025 announced rate increases of 6.12% effective October 1, 2025. CMS approved related SPAs 25-0004 and 25-0005, both effective 2025-10-01.
- Drugs outside the DRG: SPA 25-0006, on drugs reimbursed outside the DRG methodology, was approved by CMS, effective 2026-01-01.
- Nursing facilities: SPA 26-0003 on nursing facility reimbursement methodology, effective 2026-07-01, alongside a public comment period for SPA 26-0002.
- Substance use disorder: SPA 26-0004 proposes value-based payments for SUD providers, effective 2027-07-01.
The next physician schedule will take effect April 1, 2027, when the current cycle ends. Practices should plan for that date rather than January. The SUD value-based payment proposal is the clearest signal of new money for behavioral health, though it is not effective until mid-2027 and will depend on quality measures. Nursing facilities should review the methodology change under SPA 26-0003 against their own cost data before the January 2027 rate period. ABA and IDD providers, whose rates have not moved in years, have the most to gain from any future rate study.
- Virginia Medicaid pays only $41.44 for 99213 but $23.48 for 97153, against West Virginia's $9.90.
- North Carolina Medicaid pays $50.41 for 99213, $20.81 for 97153 and $8.66 for T1019.
- Georgia pays $83.82 for 99213 and $30.91 for 97153; South Carolina pays $58.11 and $14.88; Florida pays $32.58 for 99213.
West Virginia beats Virginia, North Carolina, South Carolina and Florida on office visits, but every neighbor listed pays more for ABA technician time.
Plan on the April-to-March cycle. Pull each code from the schedule edition matching the date of service, and use the rural or non-rural DME schedule as appropriate. For direct-pay services, the BMS rate is the revenue; for negotiated lines, compare plan offers with Medicare and the national median. Access to all 88,707 West Virginia rates, with history back to 2017, is covered on pricing.
All 88,707 current West Virginia rates are compiled from official state Medicaid publications, and each rate links to its source document. Named sources include the BMS RBRVS 2026 schedule, the 2026 ASC Fee Schedule, the BMS DME 2026 Rural and Non-Rural Fee Schedules, the Anesthesia, Dental and Home Health Agencies schedules, the Nursing Facility Fee Schedule, the DRG calculators and the WV Medicaid Hospice Rates. Our methodology explains rankings and unit conversions.