The Delaware Medicaid fee schedule pays physicians close to Medicare and home care agencies near the top of the country. Delaware Medicaid pays $92.63 for code 99213, rank 9 of 46 ranked states, against a Medicare non-facility amount of $94.52 and a national median of $75.27. Code 99214 ($131.96) also ranks ninth and code 99215 ($187.23) ranks eighth. Personal care code T1019 pays $14.75 per 15 minutes, second of 39 states. The weak spot is outpatient psychotherapy, where code 90837 ranks 40 of 48.
MedicaidRate holds all 46,693 current Delaware rates across 84 service categories and 7 programs, compiled from 25 official state Medicaid publications, with history back to 2008. Each rate links to its source document.
Delaware Medicaid fee schedule 2026 by code
| Code | Plain label | Delaware | National median | Rank |
|---|---|---|---|---|
| 99213 | Return visit, level 3 | $92.63 | $75.27 | 9 of 46 |
| 99214 | Return visit, level 4 | $131.96 | $108.69 | 9 of 46 |
| 99285 | Emergency department visit | $166.73 | $138.99 | 10 of 48 |
| 90837 | Psychotherapy, per hour | $100.36 | $132.38 | 40 of 48 |
| 97151 | ABA assessment by the analyst (15 min) | $43.76 | $29.14 | 4 of 41 |
| T1019 | Personal care (15 min) | $14.75 | $7.07 | 2 of 39 |
Almost every common code moved to a 2026-01-01 effective date with the DMAP 2026 Physician Fee Schedule, so Delaware's file is current. The E/M codes track Medicare closely: 99204 pays $172.47 against $175.99, and 99215 pays $187.23 against $191.05. Preventive code 99396 pays $125.54 (rank 8 of 46).
Behavioral health is the gap. Code 90834 pays $70.25 (rank 39 of 47) and H0031 pays $80.29. The non-physician assessment, code 90791, is far stronger at $169.92 (rank 11 of 44), so intake-heavy practices fare better than therapy-heavy ones.
Programs, DMAP schedules and the Diamond State Health Plan
Delaware Medicaid (fee-for-service, DMMA / DMAP) holds 46,413 rates. The rest sit in:
- Delaware PROMISE 1915(i) behavioral health HCBS (DSAMH): 140 rates
- Delaware DDDS Lifespan 1915(c) HCBS waiver: 94 rates
- Delaware Diamond State Health Plan (DSHP) managed care: 24 directed payment rates
- Delaware Pathways to Employment 1915(i) State Plan HCBS: 14 rates
- Delaware Diamond State Health Plan Plus (DSHP Plus) managed LTSS: 6 directed payment rates
- Delaware DDDS targeted case management: 2 rates
Source documents include the DMAP 2026 Physician Fee Schedule, DMAP 2026 ASC Fee Schedule, DMAP 2026 DME Fee Schedule, DMAP 2026 Dental Fee Schedule, the 2024 and 2025 Physician Fee Schedules, the PROMISE Home and Community-Based Services Service Certification and Reimbursement Manual (March 25, 2022), and the DMAP hospital file Hospital.rates.eff.10012009 for acute care inpatient and outpatient rates. Hospital outpatient is Delaware's largest service line at 21,669 rates, ahead of physician services at 14,340.
Managed care in Delaware: what DSHP plans must pay
Delaware classifies 18 service lines. The rules:
- Plans negotiate; the published rate applies out of network: physician services, hospital inpatient and outpatient, radiology, laboratory, DME, therapy, vision and hearing, and ambulance.
- Paid directly by the state, outside managed care: behavioral health, IDD services, HCBS and other services.
What makes Delaware distinctive is its 30 directed payment rates layered on the Diamond State Health Plan. For DSHP Plus nursing facility services, directed payments are set at 61%, 7% and 68% of surveyed nursing facility other-payer rates. For DSHP hospital and behavioral health inpatient and outpatient services, directed payments are set at 44% and 11.3% of average commercial rates. All are effective 2026-01-01, and CMS approved the HCBS, hospital and behavioral health, and nursing facility directed payment renewals for calendar 2026. The named plans are AmeriHealth Caritas Delaware, Delaware First Health and Highmark Health Options, with Modivcare as the transportation broker. See the Delaware managed care page.
Industry flagship rates in Delaware
| Industry | Flagship service | Delaware | Rank | vs median |
|---|---|---|---|---|
| Home health | RN visit, per 15 min | $49.07 | 4 of 14 | +104.8% |
| IDD supports | Community living, per hour | $60.49 | 6 of 29 | +73.2% |
| Home care | Personal care, per hour | $39.35 | 4 of 27 | +28.9% |
| Outpatient therapy | Physical therapy, per hour | $113.44 | 9 of 49 | +18.1% |
| ABA | Technician, per hour | $62.72 | 22 of 42 | -1.1% |
Home-based care is where Delaware pays best. Home health aide code G0156 pays $10.48 per 15 minutes, and private duty nursing pays $63.67 per RN hour, 16.1% above the median. ABA is split: technician code 97153 sits at the median, assessment code 97151 ranks fourth, but analyst-led code 97155 pays $17.66 per unit, rank 38 of 41.
Recent Delaware Medicaid rate changes
- DMAP 2026 Physician Fee Schedule: edition effective 2026-01-01, a listed change of -0.6%.
- DMAP 2026 ASC Fee Schedule: effective 2026-01-01, a listed change of 3.98%.
- DMAP 2026 Dental Fee Schedule: edition effective 2026-04-01, a listed change of 3.76%.
- CMS-approved directed payments: the HCBS fee renewal (a listed 5.0% change), the hospital and behavioral health renewal, and the nursing facility renewal, each for 2026-01-01 through 2026-12-31.
- 30 DE Reg 151: final regulations on Medicaid general eligibility requirements, published 2026-09-01.
How Delaware compares with nearby states
For 99213, Delaware's $92.63 sits just below Maryland at $94.62 and well above New Jersey at $85.38 and Pennsylvania at $35.00; the District of Columbia pays $121.13. On personal care, Delaware's $14.75 per 15 minutes is far above DC ($5.46), Pennsylvania ($6.84) and New Jersey ($6.67).
Updated 2026-10-05