Medical assistance reimbursement rates for complex outpatient visits increased.

2025-2026 Regular Session Introduced by Dave Baker and 1 co-sponsor

In 2027, MA will pay 10% more for outpatient E/M visits for chronic/intractable pain when using code G2211, with capitation increases for plans to reflect the rise.

Introduction and first reading, referred to Health Finance and Policy

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Purpose

HF 4620 proposes to increase reimbursement rates under MinnesotaCare/Medical Assistance (MA) for complex outpatient visits. The bill adds a targeted pay increase for outpatient evaluation and management (E/M) visits for chronic and intractable pain, effective January 1, 2027, and requires corresponding adjustments to capitation payments to managed care plans and county-based purchasing plans.

Key provisions

New rate increase (outpatient E/M for chronic/intractable pain):

Effective for services rendered on or after January 1, 2027.
MA reimbursements for outpatient evaluation and management visits for chronic and intractable pain would be increased by 10% over the rates in effect on December 31, 2026.
The 10% increase applies when the submitted claim includes the HCPCS add-on code G2211 (which represents a specific add-on for E/M services in complex cases).
Beginning January 1, 2027, the commissioner must increase capitation payments to managed care plans and county-based purchasing plans to reflect this rate increase.

Existing statutory framework preserved (baseline adjustments):

The bill amends Minnesota Statutes 2025 Supplement, section 256B.76, subdivision 1, to modify how physician and professional services are paid, maintaining the long-standing tiered structure:
Certain high-complexity or specialized codes (e.g., level one “office and other outpatient services” and other specified categories) are paid at the lower of submitted charges or a set percent above the June 30, 1992 rate (e.g., 25% above, for some codes).
Most other services are paid at the lower of submitted charges or 15.4% above the June 30, 1992 rate.
A historical conversion from 50th percentile of 1982 to 1989 is retained, with adjustments to maintain overall target increases/decreases.
Periodic rate adjustments remain in place (e.g., 3% increase effective January 1, 2000; prior reductions beginning July 1, 2009; further reductions/adjustments through 2014 and beyond), with specific carve-outs for certain services and provider types (e.g., home health agencies, FQHCs, rural health centers, Indian Health Service).

Who is affected

MA enrollees: Potentially affected through changes in reimbursement rates for complex outpatient visits, which can influence access and provider participation.

Physicians and licensed professionals: Providers who bill outpatient E/M visits, particularly those serving chronic and intractable pain patients, may see higher MA reimbursements starting in 2027 when using code G2211.

Managed care plans and county-based purchasing plans: Capitation payments to these plans must be increased starting January 1, 2027 to reflect the new MA rate uplift.

Timeline and procedural notes

Introduction and referral: HF 4620 introduced and referred to Health Finance and Policy on March 25, 2026.

Effective date for main new provision: January 1, 2027 (new outpatient E/M rate increase with G2211).

Prior rate framework continues: The bill largely preserves historical rate-setting methodology and rate adjustments through existing statutory provisions, with the notable exception of the January 2027 override for chronic/intractable pain E/M visits.

If you’d like, I can provide a side-by-side comparison of the current statute language with HF 4620’s proposed amendments, or a plain-language FAQ for providers and patients.

Bill

Medical assistance reimbursement rates for complex outpatient visits increased.

Summary of HF 4620 (2025-2026) – Minnesota

Purpose

Key provisions

Who is affected

Timeline and procedural notes

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