D5863 Medicaid reimbursement rates by state
Dental services. 10 state Medicaid programs publish a fee-for-service rate for D5863. Rates run from $325.00 in Maryland to $2,034.40 in Missouri, with a median of $596.10.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 10
- Median rate
- $596.10units vary by state
- Highest
- $2,034.40Missouri
- Medicare (non-facility)
- —not on the physician fee schedule
D5863 rate in every state
One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $2,034.40since 2022-07-01 | — | — | Plans must pay at least this | — | MO HealthNet fee schedule: Dental |
| ColoradoAny qualified provider (rate does not vary by provider) · Colorado HCBS waiver for persons with developmental disabilities (DD) | $1,311.83since 2024-07-01 | — | — | Paid by the state, outside plans | — | Appendix H: DIDD and Medicaid Dental Rat |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $1,191.75since 2023-07-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - HCPCS (i |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $763.18since 2019-01-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #14 CLINIC (C |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $738.98since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Dental Codes fee sch |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $453.22since 2025-07-01 | — | — | Paid by the state, outside plans | — | HCA Dental fee schedule (dental-20250701 |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal Dental (fee-for-service, Schedule of Maximum Allowances) | $450.00since 2020-03-14 | — | — | Paid by the state, outside plans | — | Medi-Cal Dental Schedule of Maximum Allo |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $370.26since 2025-09-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Denta |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $365.42since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid dental (Maryland Healthy Smiles, fee-for-service through the dental ASO) | $325.00since 2023-08-01 | — | — | Paid by the state, outside plans | — | 2026 CDT Fee Schedule - Section 508 Comp |
Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.
Frequently asked questions
What does Medicaid pay for D5863?
It depends on the state. Of the 10 states with a published fee-for-service rate, the median is $596.10. Missouri pays the most ($2,034.40) and Maryland the least ($325.00).
Which state pays the highest Medicaid rate for D5863?
Missouri, at $2,034.40, effective 2022-07-01.
Do managed-care plans pay the same rate for D5863?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The table shows the rule for each state, cited to the contract or statute.