Virginia Workers' Compensation Law Alert: 2026 Medical Fee Schedules & Ground Rules Now in Effect (Effective January 1, 2026)

Effective January 1, 2026, the Virginia Workers’ Compensation Commission (VWC) implemented the 2026 Medical Fee Schedules and Ground Rules, which set the maximum allowable fees for fee-scheduled medical services provided to injured workers under the Virginia Workers’ Compensation Act. The update applies for services rendered during the period January 1, 2026, through December 31, 2027, and is reflected in amendments to 16 VAC 30-110-10 et seq.

The VWC has published the following resources for stakeholders:

• 2026 Medical Fee Schedules
• 2026 Medical Fee Schedules Ground Rules
• 2026 Medical Fee Schedules Summary of Changes
• Medical Fee Schedule Regulations

Helpful tools for billing and review

VWC also provides additional schedule resources, including:

• MFS Calculator (designed to incorporate applicable Ground Rules adjustments at the bill level and return the combined fee schedule maximum)
• MFS Administrative Determination Notice (VWC resource referenced alongside the calculator)

Notable functionality highlighted by VWC resources includes:

• Line-level adjustments showing the impact of Ground Rule adjustment(s) on each claim line, and
• Fee calculations displayed as the calculated maximum fee per code.

These updates can affect medical billing compliance, reimbursement evaluations, reserving, and dispute strategy on Virginia workers’ compensation claims, especially where Ground Rule adjustments and regional classifications change the allowable amount at the bill level.

Questions?

For guidance on how the 2026 Medical Fee Schedules and Ground Rules may impact your claims handling, reimbursement review, vendor workflows, or dispute posture, please contact Chartwell Partner Rob Baker or another member of our Virginia Workers’ Compensation team.