WSI Fee Schedule 2026 Updates

Friday, January 2, 2026

Categories: Medical Provider All News Medical Provider Billing Agency News WSI will be implementing the following fee schedule updates for 2026. Due to the shutdown of the federal government in the fall of 2025, WSI’s first quarter update may be delayed. WSI will publish a subsequent news article notification when the 2026 Fee Schedule files are available.

1. Ambulance Fee Schedule
   • Update is based on the CPI-U.
   • Reimbursement increased by 2.7%. ​​​​​​​
2. Ambulatory Surgical Center Fee Schedule
   • Update is based on the Market Basket for hospital services.
   • WSI will reimburse for services in the Medicine Section of the AMA CPT® code set if listed on Medicare’s published list of covered ASC services.
   • Conversion factor increased by 3.3% to $136.69.
   • ASCs billing for device-intensive procedures must report a single line-item charge, which includes the charges associated with both the service and device.
3. Anesthesia Fee Schedule
   • Update is based on the same percentage increase applied to the Medical Provider Fee Schedule.
   • Conversion factor increased by 2.7% to $78.78.
4. Clinic Laboratory Fee Schedule
   • Payment is set at 250% of North Dakota’s Medicare Laboratory fee schedule.
   • Presumptive drug screening codes must be billed with CPT codes 80305, 80306, or 80307.
   • Definitive drug testing must be billed with HCPC codes G0480-G0483.
5. Dental Fee Schedule
   • Payment is set using the Usual and Customary module of the Comprehensive Healthcare model database at the 70th percentile for the Fargo geographical area using the zip code 581XX.
   • Reflects a consistent payment for providers in all locations.
6. Durable Medical Equipment Fee Schedule
   • Payment is set at 120% of North Dakota’s Medicare Fee Schedule.
7. ​​​​​​​​​​​​ Home Health Fee Schedule
   • Update is based on the Market Basket for Home Health services.
   • Reimbursement increased by 3.2%.
   • Increase is rounded to the nearest 50 cents.
   • Home Infusion Therapy (HIT) codes (HCPC “G” Codes) are under the DME fee schedule.
8. Inpatient Hospital Fee Schedule
   • Update is a blended (operating and capital) Market Basket increase for hospital services, with adjustments made for anticipated DRG weight and coding changes.
   • Market Basket base rate increased by 3.3% to $11,950.00.
   • The outlier threshold for 2026 is $80,000.00
9. Long Term Care Hospital (LTCH) Fee Schedule
   • Fee Schedule is based on Diagnosis Related Groups (DRGs).
   • Market Basket base rate increased by 3.4% to $268,500.00.
   • The outlier threshold for 2026 is $140,000.
   • The LTCH fee schedule does not incorporate any new technology add-on payments.
   • Providers must bill LTCH charges upon discharge only. WSI will not reimburse bills submitted as an interim stay.
10. Medical Provider Fee Schedule
    • Based on the Resource Based Relative Values System (RBRVS) Relative Value Unit (RVU) established by CMS.
    • All services have a single conversion factor, including Chiropractic, E&M, Pathology, Medicine, PT and OT, Radiology and Surgery codes.
    • CPT code changes from the American Medical Association (AMA) have been adopted.
    • In following Medicare’s requirements, WSI will not recognize consult codes as valid codes.
    • Conversion factor increased by 2.7% to $82.85.
11. ​​​​​​​ Outpatient Hospital Fee Schedule
    • Update is based on the Market Basket for hospital services.
    • Conversion factor increased by 3.3% to $186.85.
    • WSI will continue to allow procedures removed from Medicare’s Inpatient Only List in 2021 to be completed in an outpatient setting. ​​​​​​Any other procedures removed from Medicare’s Inpatient Only List in 2026 will also be allowed. If you have questions about this article, please send an email to [email protected].  To receive provider news, subscribe to our Email Updates list.