Updated: 04/24
101 Payment Policy and Procedure
101.01 Rate of Payment
DORS shall pay for authorized services at a rate equal to the lower of:
The Provider’s customary charge, or
The maximum rate established in the DORS Fee Schedule, which incorporates by reference the fees established by Medicare for medical or surgical procedures (120% of the Non-Facility Price in the Medicare Fee Schedule for the Baltimore Metropolitan area found in the Physician's Fee Schedule Search at
www.cms.gov) and the fees established within the Maryland Medicaid Healthy Smiles Dental Fee Schedule for dental services.
101.02 Provision of Services
The use of the Medicare Fee Schedule for medical and surgical fees does not mean that all procedures included in that schedule may be arranged, provided, or paid for by DORS. Policy associated with the provision of certain services prevails including established restrictions, reporting requirements and management review and approval, as appropriate. (Refer to
RSM 2 and
RSM 3 for policy related to provision of services.)
102 State Contracts
Contracts for the purchase of certain goods and services have been established between vendors and either the State Purchasing Bureau or DORS (see
RSM 3, Section 1009). Goods and services on contract must be purchased through the contract.
103 Hospital Fees
Fees for hospital inpatient and outpatient services are those set by the Maryland Health Services Cost Review Commission (HSCRC).
104 Exceptions to Published Fees
Exceptions to the established fees require submission of a
Fee Exception/Approval Request (RS-3h) through supervisory channels to the DDS Director, OFS Director, OBVS Director or WTC Director, as appropriate (see
RSM 3, Section 1008.03).
105 Fees
To assist staff with the use of certain standard and routine medical evaluation and treatment services, a listing of services or procedures and approved fees follows, including medical services, psychotherapy and psychological testing, and physical medicine and allied medical services. In addition, fees are provided for services which are unique to DORS or otherwise not reflected in the Medicare Fee Schedule, including dental services, and vocational and allied services. All fees listed are per visit/session (time not defined) unless specified.
Note: If a medical/surgical service is needed which is not listed, OFS and OBVS staff shall contact the OFS Director and WTC staff shall contact the WTC Assistant Director for Administration, as appropriate, to establish the correct CPT code and fee. The DDS Medical Relations Office will handle fee exceptions for DDS.
Fee Updates – Fees based on Medicare rates are updated annually and are effective April 1 of the year. Current updates are effective 4/1/2024.
