Dear RIAPA Members,

Rhode Island Medicaid has issued an important billing update affecting physician assistants. Beginning October 1, 2026, physician assistants billing Rhode Island Medicaid for certain services must include the U8 modifier in the first modifier position on the claim.

What does this mean?

In 2025, the Rhode Island General Assembly directed the Executive Office of Health and Human Services (EOHHS) to reimburse certain Medicaid primary care services at 100% of the applicable Medicare reimbursement rate and to update those rates annually.

As part of the implementation of these updated primary care reimbursement rates, Rhode Island Medicaid is establishing a specific billing requirement for services provided by physician assistants.

What PAs and practices need to do

Effective October 1, 2026:

When a physician assistant provides one of the services identified by Rhode Island Medicaid below, the claim must include the U8 modifier in the FIRST modifier position/field.

This is particularly important for members whose claims are submitted by a hospital, health system, physician practice, billing company, or other centralized billing department. We encourage members to share this information with their practice administrators and billing/coding teams before October 1 to ensure their systems are appropriately configured.

Rhode Island Medicaid has advised that failure to comply with this requirement could result in post-payment review and recoupment of payments.

Codes Subject to the U8 Requirement

The codes identified by Rhode Island Medicaid include:

Office/Outpatient E/M:
99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215

Preventive Medicine:
99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397

Immunization Administration:
90460, 90461, 90471, 90472, 90473, 90474

Critical Care:
99291, 99292

Nursing Facility Services:
99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316

Home/Residence Services:
99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350

Additional Care Management, Communication and Related Services:
99406, 99407, 99415, 99416, 99421, 99422, 99423, 99424, 99425, 99426, 99427, 99437, 99439, 99446, 99447, 99448, 99449, 99451, 99452, 99453, 99454, 99455, 99456, 99457, 99458, 99459, 99461, 99473, 99474, 99483, 99484, 99487, 99489, 99490, 99491, 99492, 99493, 99494, 99495, 99496, 99497, 99498

Medicare/Preventive Visit Codes included in the Medicaid notice:
G0402, G0438, G0439

Bottom Line

If you are a physician assistant providing services to Rhode Island Medicaid patients:

October 1, 2026 = U8 modifier required in the first modifier position for the applicable codes listed above.

RIAPA strongly encourages members to forward this notice to the individual or department responsible for Medicaid billing within their organization.

Please note that this communication is intended to summarize guidance provided by Rhode Island Medicaid. Providers and billing departments should continue to follow current Rhode Island Medicaid billing guidance and contact Rhode Island Medicaid Provider Services with questions regarding specific claims or billing circumstances.