Medicaid rates by billing code
14,218 CPT and HCPCS codes with published Medicaid fee-for-service rates in at least five states, compared state by state. Pick a service area, or go straight to a code.
Physician & professional 7,291 codes
10004Physician and practitioner services (fee schedule) · 19 states10005Physician and practitioner services (fee schedule) · 19 states10006Physician and practitioner services (fee schedule) · 19 states10007Physician and practitioner services (fee schedule) · 19 states10008Physician and practitioner services (fee schedule) · 19 states10009Physician and practitioner services (fee schedule) · 19 states10010Physician and practitioner services (fee schedule) · 19 states10021Physician and practitioner services (fee schedule) · 19 states10030Physician and practitioner services (fee schedule) · 19 states10035Physician and practitioner services (fee schedule) · 19 states10036Physician and practitioner services (fee schedule) · 19 states10060Physician and practitioner services (fee schedule) · 19 states10061Physician and practitioner services (fee schedule) · 19 states10080Physician and practitioner services (fee schedule) · 19 states10081Physician and practitioner services (fee schedule) · 19 states10120Physician and practitioner services (fee schedule) · 19 states
Equipment & supplies 2,286 codes
A4635Underarm pad, crutch, replacement, each · 19 statesA4636Replacement, handgrip, cane, crutch, or walker, each · 19 statesA4637Replacement, tip, cane, crutch, walker, each. · 19 statesA7000Canister, disposable, used with suction pump, each · 19 statesA7005Administration set, with small volume nonfiltered pneumatic... · 19 statesA7015Aerosol mask, used with dme nebulizer · 19 statesA8000Helmet, protective, soft, prefabricated · 19 statesA8001Helmet, protective, hard, prefabricated · 19 statesB9002Enteral nutrition infusion pump, any type · 19 statesE0100Cane, includes canes of all materials, adjustable or fixed · 19 statesE0105Cane, quad or three prong, includes canes of all materials · 19 statesE0130Walker, rigid (pickup), adjustable or fixed height · 19 statesE0135Walker, folding (pickup), adjustable or fixed height · 19 statesE0141Durable medical equipment · 19 statesE0143Walker, folding, wheeled, adjustable or fixed height · 19 statesE0149Walker, heavy duty, wheeled, rigid or folding, any type · 19 states
Lab & pathology 1,716 codes
80047Clinical lab tests · 19 states80051Clinical lab tests · 19 states80053Clinical lab tests · 19 states80061Clinical lab tests · 19 states80069Clinical lab tests · 19 states80076Clinical lab tests · 19 states80150Clinical lab tests · 19 states80156Clinical lab tests · 19 states80157Clinical lab tests · 19 states80158Clinical lab tests · 19 states80159Clinical lab tests · 19 states80162Clinical lab tests · 19 states80164Clinical lab tests · 19 states80168Clinical lab tests · 19 states80169Clinical lab tests · 19 states80170Clinical lab tests · 19 states
Pharmacy 1,240 codes
90651Vaccines and immune globulins · 17 states90656Vaccines and immune globulins · 17 states90658Vaccines and immune globulins · 17 states90620Vaccines and immune globulins · 17 states90621Vaccines and immune globulins · 17 states90714Vaccines and immune globulins · 17 states90715Vaccines and immune globulins · 17 states90739Physician-administered drugs (J-codes) · 17 states90740Vaccines and immune globulins · 17 statesQ4101Apligraf, per square centimeter (add-on · 17 statesJ1459Injection, immune globulin (privigen), intravenous · 16 statesJ1561Injection, immune globulin, (gamunex-c/gammaked) · 16 statesJ1568Injection, immune globulin, (octagam), intravenous · 16 statesJ1569Injection, immune globulin, · 16 statesQ4081Injection, epoetin alfa, 100 units (for esrd on dialysis) · 16 states90747Physician-administered drugs (J-codes) · 16 states
Radiology 670 codes
70010Imaging and radiology · 19 states70015Imaging and radiology · 19 states70030Imaging and radiology · 19 states70100Imaging and radiology · 19 states70110Imaging and radiology · 19 states70120Imaging and radiology · 19 states70130Imaging and radiology · 19 states70134Imaging and radiology · 19 states70140Imaging and radiology · 19 states70150Imaging and radiology · 19 states70160Imaging and radiology · 19 states70170Imaging and radiology · 19 states70190Imaging and radiology · 19 states70200Imaging and radiology · 19 states70210Imaging and radiology · 19 states70220Imaging and radiology · 19 states
Dental 360 codes
D7140Dental services · 17 statesD7210Dental services · 17 statesD7220Dental services · 17 statesD7230Dental services · 17 statesD7240Dental services · 17 statesD7250Dental services · 17 statesD7270Dental services · 17 statesD7280Dental services · 17 statesD0120Dental services · 17 statesD0150Dental services · 17 statesD1110Dental services · 17 statesD1120Dental services · 17 statesD1351Dental services · 17 statesD1510Dental services · 17 statesD2330Dental services · 17 statesD2331Dental services · 17 states
Vision & hearing 185 codes
92060Eye exams and vision services · 19 states92083Eye exams and vision services · 19 states92134Eye exams and vision services · 19 states92235Eye exams and vision services · 19 states92242Eye exams and vision services · 19 states92265Eye exams and vision services · 19 states92270Eye exams and vision services · 19 states92550Hearing tests and audiology services · 19 states92552Hearing tests and audiology services · 19 states92553Hearing tests and audiology services · 19 states92555Hearing tests and audiology services · 19 states92651Hearing tests and audiology services · 19 states92652Hearing tests and audiology services · 19 states92653Hearing tests and audiology services · 19 states92025Eye exams and vision services · 18 states92240Eye exams and vision services · 18 states
Behavioral health 175 codes
90791Mental health assessment (non-physician) · 19 states90832Outpatient psychotherapy and diagnostic evaluation · 19 states90834Outpatient psychotherapy and diagnostic evaluation · 19 states90837Outpatient psychotherapy and diagnostic evaluation · 19 states90847Outpatient psychotherapy and diagnostic evaluation · 19 states90853Outpatient psychotherapy and diagnostic evaluation · 19 states96110Mental health assessment (non-physician) · 19 states96112Mental health assessment (non-physician) · 19 states96113Mental health assessment (non-physician) · 19 states96130Mental health assessment (non-physician) · 19 states96131Mental health assessment (non-physician) · 19 states96132Mental health assessment (non-physician) · 19 states96133Mental health assessment (non-physician) · 19 states96136Mental health assessment (non-physician) · 19 states96137Mental health assessment (non-physician) · 19 states96372Medication training and support · 19 states
Hospital inpatient 104 codes
H0046Mental health services, not otherwise specified · 8 states113Inpatient DRG pricing input (outlier, cost ratio, stay) · 5 states135Inpatient DRG pricing input (outlier, cost ratio, stay) · 5 states136Inpatient DRG pricing input (outlier, cost ratio, stay) · 5 states137Inpatient DRG pricing input (outlier, cost ratio, stay) · 5 states139Inpatient DRG pricing input (outlier, cost ratio, stay) · 5 states141Inpatient DRG pricing input (outlier, cost ratio, stay) · 5 states143Inpatient DRG pricing input (outlier, cost ratio, stay) · 5 states163Inpatient DRG relative weight · 5 states165Inpatient DRG pricing input (outlier, cost ratio, stay) · 5 states166Inpatient DRG pricing input (outlier, cost ratio, stay) · 5 states177Inpatient DRG pricing input (outlier, cost ratio, stay) · 5 states178Inpatient DRG relative weight · 5 states180Inpatient DRG pricing input (outlier, cost ratio, stay) · 5 states191Inpatient DRG pricing input (outlier, cost ratio, stay) · 5 states193Inpatient DRG pricing input (outlier, cost ratio, stay) · 5 states
Therapy (PT/OT/speech) 41 codes
92507Speech therapy session (one person) · 19 states92521Stuttering evaluation · 19 states92522Articulation evaluation · 19 states92523Articulation and language evaluation · 19 states92524Voice evaluation · 19 states92610Swallowing assessment · 19 states97530Functional activity training · 19 states97110Exercise therapy for strength and range of motion · 18 states97112Balance and coordination retraining · 18 states97163Physical therapy evaluation, level 3 of 3 · 18 states97167Occupational therapy evaluation, level 3 of 3 · 18 states92526Swallowing and feeding therapy · 17 states97036Other therapy services · 17 states97113Other therapy services · 17 states97161Physical therapy evaluation, level 1 of 3 · 17 states97162Physical therapy evaluation, level 2 of 3 · 17 states
Hospital outpatient 34 codes
31603Emergency department APG base rate · 19 states50200Outpatient clinic visit APG base rate · 19 states50555Outpatient clinic visit APG base rate · 19 states50561Outpatient clinic visit APG base rate · 19 states50592Outpatient clinic visit APG base rate · 18 states50606Outpatient clinic visit APG base rate · 18 states21110Outpatient clinic visit APG base rate · 17 statesT2005Emergency department APG base rate · 7 statesS0209Emergency department APG base rate · 6 states114Outpatient clinic visit APG base rate · 5 states115EAPG relative weight (outpatient hospital or surgery center) · 5 states121EAPG relative weight (outpatient hospital or surgery center) · 5 states138EAPG relative weight (outpatient hospital or surgery center) · 5 states167EAPG relative weight (outpatient hospital or surgery center) · 5 states175EAPG relative weight (outpatient hospital or surgery center) · 5 states179APG relative weight · 5 states
Other home & community services 28 codes
T1017Targeted case management, each 15 minutes · 13 statesT1016Case management, each 15 minutes · 12 statesS5102Day care services, adult; per diem · 12 statesS5170Home delivered meals, including preparation; per meal · 12 statesG0101Respite care (daily) · 11 statesT1005Respite care services, up to 15 minutes · 11 statesS5150Unskilled respite care, not hospice; per 15 minutes · 10 statesS5161Emergency response system; service fee, per month · 10 statesT2025Waiver services; not otherwise specified (nos) · 10 statesH0045Respite care services, not in the home, per diem · 9 statesS5160Emergency response system; installation and testing · 9 statesT1001Nursing assessment / evaluation · 9 statesT2022Case management, per month · 9 statesS5199Personal care item, nos, each · 8 statesT2038Community transition, waiver; per service · 8 statesS5151Unskilled respite care, not hospice; per diem · 7 states
Transportation 25 codes
A0428Ambulance service, basic life support · 18 statesA0429Ambulance service, basic life support, emergency transport · 18 statesA0426Ambulance service, advanced life support · 17 statesA0427Ambulance service, advanced life support · 17 statesA0431Ambulance service, conventional air services, transport · 17 statesA0433Advanced life support, level 2 (als 2) · 17 statesA0425Ground mileage, per statute mile · 16 statesA0430Ambulance service, conventional air services, transport · 16 statesA0436Rotary wing air mileage, per statute mile · 16 statesA0434Specialty care transport (sct) · 15 statesA0435Fixed wing air mileage, per statute mile · 14 statesS0215Non-emergency transportation; mileage, per mile · 13 statesT2003Non-emergency transportation; encounter/trip · 13 statesA0130Non-emergency transportation: wheelchair van · 12 statesA0120Non-emergency transportation: mini-bus · 9 statesA0420Ambulance waiting time (als or bls), one half · 9 states
IDD services 14 codes
T2021Day habilitation, waiver; per 15 minutes · 8 statesT2023Targeted case management; per month · 8 statesT2033Residential care, not otherwise specified (nos), waiver · 8 statesH2023Supported employment, per 15 minutes · 7 statesT2015Habilitation, prevocational, waiver; per hour · 7 statesT2019Habilitation, supported employment, waiver; per 15 minutes · 7 statesH0043Supported housing, per diem · 6 statesH2016Comprehensive community support services, per diem · 6 statesH2025Ongoing support to maintain employment, per 15 minutes · 6 statesT2031Assisted living; waiver, per diem · 6 statesG0246Intervener for a person who is deaf-blind · 5 statesG0247Intervener for a person who is deaf-blind · 5 statesT2013Habilitation, educational, waiver; per hour · 5 statesT2020Day habilitation, waiver; per diem · 5 states
ABA / autism services 11 codes
97151Behavior assessment and treatment plan by the analyst · 16 states97153One-on-one ABA therapy by a technician · 16 states97154Group ABA therapy by a technician · 16 states97155ABA therapy led by the analyst (plan adjusted in session) · 16 states97156ABA parent or caregiver training by the analyst · 15 states97158Group ABA therapy led by the analyst · 13 states97152Behavior assessment help from one technician · 11 states97157ABA parent or caregiver training for several families · 11 states0373TABA therapy with two or more technicians on site · 8 statesT1027Family training and counseling for child development · 8 states0362TBehavior assessment help from two or more technicians · 7 states
Home health 11 codes
G0299Direct skilled nursing services of a registered nurse · 11 statesG0151Services performed by a qualified physical therapist in the... · 10 statesG0152Services performed by a qualified occupational therapist in... · 10 statesG0300Direct skilled nursing services of a licensed practical... · 10 statesG0153Services performed by a qualified speech-language... · 9 statesG0156Services of home health/hospice aide in home health or... · 8 statesT1030Nursing care, in the home, by registered nurse, per diem · 7 statesG0493Skilled services of a registered nurse · 5 statesS9129Occupational therapy, in the home, per diem · 5 statesT1021Home health aide or certified nurse assistant, per visit · 5 statesT1031Nursing care, in the home, by licensed practical nurse · 5 states
Personal care & attendant 9 codes
T1019Personal care services, per 15 minutes · 14 statesS5130Homemaker service, nos; per 15 minutes · 11 statesS5125Attendant care services; per 15 minutes · 9 statesS9122Home health aide or certified nurse assistant · 8 statesT1004Services of a qualified nursing aide, up to 15 minutes · 7 statesT1020Personal care services, per diem · 7 statesS5135Companion care, adult (e.g., iadl/adl); per 15 minutes · 6 statesS5116Home care training, non-family; per session · 5 statesS5136Companion care, adult (e.g., iadl/adl); per diem · 5 states
Private duty nursing 8 codes
T1002Rn services, up to 15 minutes · 15 statesT1003Lpn/lvn services, up to 15 minutes · 15 statesS9123Nursing care, in the home; by registered nurse, per hour · 13 statesS9124Nursing care, in the home; by licensed practical nurse · 11 statesT1000Private duty / independent nursing service(s) - licensed · 9 statesG2252Waiver nursing (RN or LPN, by the 15 minutes) · 7 statesG2250Waiver nursing (RN or LPN, by the 15 minutes) · 6 statesG2251Waiver nursing (RN or LPN, by the 15 minutes) · 6 states
Other 5 codes
Hospice 4 codes
Clinics (FQHC/RHC) 1 codes
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