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1303 Hospital Ground • Knud Hansen Complex, Suite 1 • St. Thomas, Virgin Islands 00802-6722 • (340) 774-0930 3012 Golden Rock • Christiansted, St. Croix, Virgin Islands 00820 • (340) 718-2980 Medicaid Program Public Notice Physician Reimbursement Update for Interventional Cardiology Services October 28, 2025 The U.S. Virgin Islands (USVI) Department of Human Services (DHS) is issuing this Public Notice of its intention to submit a Medicaid State Plan Amendment (SPA) request to the Centers for Medicare & Medicaid Services (CMS) in compliance with 42 CFR §447.205 to update the reimbursement methodology for on-island physician payments for interventional cardiology services. The purpose of the SPA is to incorporate physician provider payment updates with the goal of supporting member access to services. The anticipated effective date of the SPA for the payment increase is December 1, 2025. Effective for dates of service on and after December 1, 2025, on-island physician interventional cardiology procedure services will be paid per CPT code for both inpatient and outpatient services according to the current Virgin Islands Medicare fee schedule at the global non-facility rate. It is estimated that the payment increase will have a total cost of approximately $20,500 annually to be reimbursed by the federal and Virgin Islands Territory Medicaid funding. There is no public meeting scheduled regarding this notice. A copy of the proposed Medicaid State Plan Amendment describing the updated reimbursement methodology is available for review at: https://dhs.vi.gov/. Any interested party wishing to request a written copy of the SPA or wishing to submit comments may do so by sending an email to map.public.comment@berrydunn.com, calling the Department of Human Services at (340) 774-0930, or by submitting a request in writing to the following address: USVI Department of Human Services Attn: Director, Medicaid Program 1303 Hospital Ground – Knud Hansen Complex-Building A St. Thomas, US Virgin Islands 00802 We invite your comments on the proposal and those comments must be received by DHS within 30 days of the date of this notice. STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State/Territory: US Virgin Islands Attachment 4.19-B __________________________________________________________________________________ TN: 25-0001 Approval Date: Effective Date: 12/01/2025 Supersedes: VI-13-006 Methods and Standards for Establishing Payment Rates-Other Types of Care 4) EPSDT a) Examination, screening, testing and treatment rates paid per CPT code according to the fee schedule attached to each provider's Provider Agreement. 5) Family Planning a) Reimbursement for services paid per CPT code according to the current Virgin Islands Medicare fee schedule (area-50) that can be found at www.cms.gov/physicianfeesched/. 6) Physicians and Other Practitioner's Services a) For on-island and off-island services provided by physicians, and other practitioners attendant to a referral from the Department of Human Services or its agent, reimbursement will be paid per CPT for both inpatient and outpatient services according to the current Virgin Islands Medicare fee schedule. (www.cms.gov/physicansfeesched/). b) Effective for dates of service on and after December 1, 2025, on-island physician interventional cardiology procedure services will be paid per CPT code for both inpatient and outpatient services according to the current Virgin Islands Medicare fee schedule at the global non-facility rate. (www.cms.gov/physicansfeesched/). Unless otherwise noted in the State Plan, public and private providers are reimbursed at the same rate. 7) Home Health Services a) Home Health Agency services are reimbursed based on the Virgin Island Medicare fee schedule. b) Home Health Aide services are reimbursed based on the Virgin Island Medicare fee schedule. 8) Medical Equipment and Supplies a) Reimbursed according to the Virgin Island Medicare fee schedule. 9) Clinic Services a) Reimbursed according to the current Virgin Island Medicare fee schedule by procedure code. 10) Dental Services a) The fees in the referenced State's fee schedules are effective as of January 1, 2014, for services provided on or after that date and are published on the Department's fiscal agent's website at www.vimmis.com under the link for "rate code and information." 11) Tobacco Cessation Services a) For on-island and off-island services provided by physicians and other practitioners attendant to a referral from the Department of Human Services or its agent, reimbursement will be paid per CPT for outpatient services according to the current Virgin Islands Medicare fee schedule (www.cms.gov/physicansfeessched/).