The District of Columbia Medicaid fee schedule pays physicians above Medicare on its core office visits. DC Medicaid pays $121.13 for code 99213, rank 5 of 46 ranked states and above the $106.56 Medicare non-facility amount. New-patient codes 99203 ($182.93) and 99204 ($257.08) both rank second in the nation, and level-5 return visit 99215 pays $214.58, the same figure as Medicare. Advanced life support ambulance code A0427 pays $2,588.96, the highest of 44 states.
MedicaidRate holds all 87,654 current DC rates across 99 service categories and 7 programs, compiled from 29 official publications from the Department of Health Care Finance (DHCF), with history back to 1978. Each rate links to its source document.
DC Medicaid fee schedule 2026: rates above Medicare
| Code | Plain label | DC Medicaid | National median | Rank |
|---|---|---|---|---|
| 99213 | Return visit, level 3 | $121.13 | $75.27 | 5 of 46 |
| 99214 | Return visit, level 4 | $170.57 | $108.69 | 4 of 46 |
| 99204 | New visit, level 3 of 4 | $257.08 | $142.06 | 2 of 46 |
| 90837 | Psychotherapy, per hour | $150.43 | $132.38 | 12 of 48 |
| H0031 | Mental health assessment, non-physician | $295.78 | $123.95 | 3 of 31 |
| A0427 | Advanced life support ambulance | $2,588.96 | $387.24 | 1 of 44 |
For a practice, the E/M numbers are the headline. Code 99214 pays $170.57 against a Medicare amount of $151.49, and 99204 pays $257.08 against $197.64. Psychotherapy is strong but below Medicare: 90837 at $150.43 compares with a $181.03 Medicare amount, and 90834 pays $112.83 (rank 9 of 47). Preventive code 99396 pays $115.00 (rank 10 of 46).
DHCF programs and MMIS fee schedule reports
Physician and practitioner services dominate DC's file, with 73,073 of the 87,654 rates. The programs on file:
- DC Medicaid (DHCF) fee-for-service: 83,749 rates
- DC Medicaid FFS (hospital): 3,357 rates
- DC Intellectual and Developmental Disabilities (IDD) 1915(c) waiver (DDS): 435 rates
- DC Medicaid FFS (ICF/IID): 72 rates
- DC Elderly and Persons with Physical Disabilities (EPD) 1915(c) waiver: 20 rates
- DC Medicaid FFS (nursing facility): 12 rates
- DC Individual and Family Support (IFS) 1915(c) waiver (DDS): 9 rates
DHCF publishes its schedules as numbered MMIS reports, all dated as of 09/26/2026: REFRP00178CSV - Medical Fee Schedule Report, REFRP00179CSV - Dental Fee Schedule Report, REFRP00180CSV - Anesthesia Fee Schedule Report, REFRP00181CSV - ASC Fee Schedule Report, and the Provider ID and Provider Type Fee Schedule Reports. Hospital payment follows the DC APR-DRG Pricing Calculator effective 2026-10-01 and the DC EAPG Relative Weights FY2026.
Managed care in DC: what plans must pay
Eight DC service lines are classified, and four bind plans to the published rate:
- Plans must pay at least the published rate: hospital inpatient, hospital outpatient, laboratory and pathology, and FQHC, RHC and clinic services.
- Paid directly by the District, outside managed care: physician and practitioner services and behavioral health.
That means a hospital or lab contracting with a DC plan can treat the DHCF rate as a floor. The named plans are AmeriHealth Caritas District of Columbia, MedStar Family Choice DC, Health Services for Children with Special Needs (HSCSN), Edenbridge PACE and UnitedHealthcare of the Mid-Atlantic D-SNP. One plan change matters this year: under Transmittal 26-19, Wellpoint DC exits and its enrollees were auto-assigned to AmeriHealth Caritas DC effective August 1, 2026. See the DC managed care page.
Industry flagship rates in DC
| Industry | Flagship service | DC | Rank | vs median |
|---|---|---|---|---|
| ABA | Technician, per hour | $110.00 | 4 of 42 | +73.4% |
| Behavioral health | Counseling (H0046) | $35.74 | 3 of 12 | +36.5% |
| Home health | RN visit (G0299) | $155.16 | 1 of 14 | +547.4% |
| Outpatient therapy | Physical therapy, per hour | $103.52 | 16 of 49 | +7.8% |
| Private duty nursing | RN, per hour (S9123) | $28.00 | 39 of 43 | -48.9% |
ABA and counseling rates are among the strongest in the country. Home health leads all 14 ranked states: code G0299 with modifier TD pays $155.16 per 15-minute unit from 2026-10-01, the highest RN visit rate on file. Private duty nursing under S9123 still carries a 2003-09-01 rate, while independent nursing code T1000 pays $16.15 per 15 minutes (rank 6 of 18). Personal care code T1019 pays $5.46 per 15 minutes (rank 31 of 39), below the $7.07 national median; attendant care code S5125 pays $4.08 on a 2006 rate.
Recent DC Medicaid rate changes
- Hospital payment updates effective 2026-10-01: the DC APR-DRG FAQ (DCI26003) lists a 3.1% change and the EAPG FY2027 FAQ (DCO26005) lists a 1.9% change; a Specialty Hospital FAQ (DCS26003) took effect the same day.
- Transmittal 26-25: Skilled Nursing Rate Changes Effective October 1, 2026.
- D.C. Register notice N146585 (2026-09-25): proposed State Plan amendment on reimbursement for general hospitals.
- Individual and Family Support Waiver: final rulemaking amending 29 DCMR Ch. 90, published 2026-08-28.
- Transmittal 26-19: Wellpoint DC exit, effective August 1, 2026.
How DC compares with nearby states
DC is at the top of its region on office visits and ABA. For 99213, Maryland pays $94.62, Delaware $92.63, New Jersey $85.38, New York $86.75 and Pennsylvania $35.00. For ABA code 97153, DC's $27.50 per unit compares with $20.91 in Maryland and $15.68 in Delaware.
Updated 2026-10-05