The FY2027 PBHS Fee Schedule Is Live: What Maryland Behavioral Health Providers Need to Check Now

On July 6, 2026, Carelon published updated fee schedules for the Maryland Public Behavioral Health System covering fiscal year 2027. New schedules took effect for every major provider category: individual practitioners and OMHCs, PRP and specialty programs, SUD programs, and 1915(i) intensive services.

If you have not yet pulled the new fee schedule and compared it against what your billing system is using, that is the single most important thing you can do this week. Billing at the wrong rate -- whether too high or too low -- creates problems that are far more expensive to fix after the fact than to catch now.

What Changed and Where to Find It

The FY2027 schedules are published on Carelon's provider fee schedule page at maryland.carelonbh.com. The specific documents effective July 6, 2026 are:

• FY2027 PBHS Fee Schedule -- Individual Practitioner and OMHC (effective 7.6.2026)
• FY2027 PBHS Fee Schedule -- PRP and Specialty Programs (effective 7.6.2026)
• FY2027 PBHS Fee Schedule -- SUD (effective 7.6.2026)
• FY2027 PBHS Fee Schedule -- 1915(i) (effective 7.6.2026)

Note that the crisis services fee schedule has not been updated since August 2025, and the health home schedule has not been updated since July 2025. If you bill crisis or health home services, the FY2026 schedules remain in effect for those categories until further notice.

The 1% Context

As covered in the workforce and reimbursement article published here last month, Maryland behavioral health providers received a 1% rate increase for fiscal year 2026, with providers having requested 3%. The FY2027 fee schedule reflects this year's rate adjustments, which are modest. Do not expect significant increases -- the budget environment that produced a 1% increase last year has not materially improved for FY2027.

That said, modest changes to specific procedure codes can still have meaningful impact on your revenue, particularly for high-volume codes billed hundreds of times per month. A $2 change on a code you bill 300 times monthly is $600 per month -- $7,200 annually. Whether that change is an increase or decrease makes a real difference, and the only way to know is to look at the actual schedule for your specific codes.

What Your Billing Team Should Do Right Now

Pull the Current Schedule for Your Program Type

Download the fee schedule for every program type you operate. Do not rely on what was in effect last year. The schedules are PDFs available directly from Carelon's fee schedule page -- download and save the new versions dated 7.6.2026.

Compare Against Your Billing System

Your billing software or clearinghouse likely has fee schedule tables that need to be updated to reflect the new rates. If those tables are not updated, claims submitted after July 6 may go out with the old rates. For many billing systems, this update is not automatic -- someone has to manually update the fee schedule table or confirm that your software vendor has pushed the update.

Ask your billing team or software vendor directly: has the FY2027 PBHS fee schedule been loaded? When was it applied? To which codes?

Identify Any Code-Level Changes

Fee schedule updates do not always affect every code uniformly. Some codes may receive rate increases; others may see no change; and occasionally codes are added, removed, or have their units or modifiers changed. A line-by-line comparison of the new schedule against the old one for your most frequently billed codes is the most reliable way to catch anything that affects your specific program.

Update Your Charge Master

If your practice maintains an internal charge master (the list of your standard charges by procedure code), it should be updated to reflect the new rates. A charge master that does not align with the current Medicaid fee schedule creates reconciliation headaches and can complicate internal revenue projections.

Check Claims Submitted Since July 6

If any claims were submitted between July 6 and the date you updated your fee schedule tables, review them for rate accuracy. Claims submitted at the old rate may have been paid at the new rate (if higher) or may generate discrepancies in your accounts receivable reconciliation. Catch these early rather than during a quarterly close.

A Note on the PRP Billing Cascade

PRP programs should also check whether Carelon has published an updated FY2027 Billing Cascade document alongside the PRP and Specialty Programs fee schedule. The billing cascade -- which governs how PRP services are billed when a client receives multiple service types on the same day -- is a separate document that has historically been updated alongside the main fee schedule. As of the July 6, 2026 publication, confirm with Carelon's provider resources page whether an updated cascade applies.

The Broader Revenue Cycle Connection

Fee schedule verification is one piece of a broader revenue cycle discipline that becomes more important as Medicaid rates remain constrained. When rate increases are small, the margin for administrative revenue loss shrinks. Every claim submitted at the wrong rate, every denied claim left unworked, and every authorization gap that renders a service unbillable is a cost the practice can increasingly not afford to absorb.

For behavioral health practices operating on Medicaid reimbursement, the difference between a well-managed revenue cycle and a poorly managed one is often the difference between financial viability and not. The fee schedule update is a routine annual event -- but treating it as routine means doing the routine work: pulling the new schedule, verifying your system, and catching discrepancies before they compound.