The Iowa Department of Health and Human Services (HHS), pursuant to the requirements outlined in 42 C.F.R. §447.205, hereby gives notice of the following proposed action regarding changes to the reimbursement rates provided by dentists, home health agencies, and prosthetists/orthotists for services under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Summary of Submission:
Pursuant to the authority of 2025 Iowa Acts, House File (HF) 1049, Section 15, the following Medicaid reimbursement rates shall be increased effective July 1, 2025:
- Home Health LUPA rate rebase: +0.00% (budget neutral in aggregate)
- Prosthetic and orthotic devices/items provided by prosthetists/orthotists: +3.80%
- Dentist rates will be increased as follows:
- Diagnostic services: +11.10%
- Endodontics services: +5.45%
- Preventive services: +18.00%
- Prosthodontics removable services: +27.21%
- Restorative services: +10.87%
- Procedure code D7111, extraction, coronal remnants-deciduous: +10.77%
- Procedure code D7140, extraction, erupted tooth or exp. root: +7.84%
- Procedure code D9110, palliative tx dental plan: +12.31%
- Procedure code D9222, deep sedation/general anesthesia-first 15 min: +9.17%
- Procedure code D9223, deep sedation/general anesthesia-each addtl 15 min: +5.17%
- Procedure code D9230, inhale of nitrous oxide: +26.84%
- Procedure code D9239, intravenous moderate sedation/analgesia-first 15 min: +2.53%
- Procedure code D9243, intravenous moderate sedation/analgesia-each addtl 15 min: +0.98%
- Procedure code D9410, house call: +26.75%
- Procedure code D9420, hosp or ambulatory surg center call: +47.82%
- Procedure code D9440, office visit after hours: +2.32%
- Procedure code D9610, therapeutic drug injection: +10.35%
Estimated Fiscal Impact
The estimated increase in Medicaid fee-for-service (FFS) expenditures for State Fiscal Year (SFY) 2026 related to the Medicaid reimbursement rate change is:
Total Dollars: $ 10,130
Federal Dollars: $ 7,090
State Dollars: $ 3,040
Public Review and Comments
A copy of the SPA-IA-25-0027 and public notice is posted on the HHS website at the following link: https://hhs.iowa.gov/public-notice/2025-06-27/public-notice-state-plan-amendment-spa-ia-25-0027-house-file-hf-1049-rate-changes
To reach all stakeholders, non-electronic copies will be made available for review at each local HHS office.
Submission of Comments
Written comments may be addressed to Quality/Innovation and Medical Policy Bureau, Department of Health and Human Services, Iowa Medicaid, 321 East 12th St., Des Moines, IA 50319-0114. Comments may also be sent via electronic mail to: QIMP_Public_Comment@hhs.Iowa.gov through July 27, 2025, at 4:30 P.M. Please indicate SPA IA-25-0027 in the subject line of the email.
All written and emailed comments must be received no later than July 27, 2025 by 4:30 p.m.
Submitted by:
Rebecca Curtiss, Interim Medicaid Director
Iowa Department of Health and Human Services