Idaho Medicaid pays $86.12 for code 99213, the most-billed return office visit, which ranks 13 of 46 states against a national median of $75.27. The Idaho Medicaid fee schedule refreshed every common physician and behavioral health code on 2026-07-01, and those codes now sit in the top half of the country. Long-term services tell the opposite story: personal care and IDD supports rank near the bottom, many of them still carrying the dates of the state's 4% provider rate reductions.
MedicaidRate holds all 23,716 current Idaho rates across 116 service categories and 10 programs, compiled from 41 official state Medicaid publications, with history back to 2008. Each rate links to its source document.
Most Idaho professional rates come from the Idaho Medicaid Numerical Fee Schedule July to September 2026 (Version: 1.4). Physician and practitioner services make up 8,314 of the current rates, followed by hospital outpatient with 5,086.
| Code | Plain label | Idaho rate | National median | Rank |
|---|---|---|---|---|
| 99213 | Return office visit, level 3 | $86.12 | $75.27 | 13 of 46 |
| 99214 | Return office visit, level 4 | $122.69 | $108.69 | 13 of 46 |
| 99215 | Return office visit, level 5 | $174.09 | $147.31 | 12 of 46 |
| 99396 | Adult preventive visit | $111.96 | $97.92 | 12 of 46 |
| A0427 | Advanced life support ambulance | $441.33 | $387.24 | 14 of 44 |
| 59400 | Routine obstetric care package | $1,709.70 | $2,092.38 | 31 of 40 |
Idaho's office visits sit close to Medicare. The Medicare non-facility figure on file for 99213 is $89.71, and for 99215 it is $181.34, against Idaho rates of $86.12 and $174.09. New-patient visits rank a little lower: 99203 pays $105.65 (rank 16 of 46) and 99204 pays $159.87 (rank 17 of 46). The emergency department code 99285 pays $139.24, almost exactly the $138.99 median (rank 23 of 48).
Obstetrics is the weak point among physician codes. A family practice or OB group weighing Medicaid deliveries should note that the global package ranks 31 of 40.
Idaho is two different markets under one Medicaid program. Physicians and outpatient therapists are paid in the top half of the country, close to Medicare on office visits. Agencies providing personal care, attendant care and developmental disability supports are paid near the bottom.
For a physician practice, that makes Medicaid a reasonable payer to build around, and the quarterly numerical schedule keeps rates current. For a home care or IDD agency, the low hourly rates compress margins after wages, travel and supervision. Those agencies should plan carefully around staffing costs, and watch for any reversal of the 2025 reductions.
Multi-service organizations, such as community health centers that also run home-based programs, should model each line separately rather than averaging them. A strong physician schedule does not offset the low HCBS rates on its own.
The statewide behavioral health plan
Idaho runs behavioral health through a single statewide prepaid plan, the Idaho Behavioral Health Plan. Optum Idaho held it until 6/30/2024 and Magellan of Idaho took over on 7/1/2024. The plan's own schedule, Magellan Idaho Behavioral Health Plan Rates, Effective 11/1/2025, accounts for 1,616 of Idaho's rates.
Fee-for-service psychotherapy
On the fee-for-service schedule, outpatient psychotherapy pays above the median:
- Code 90837 pays $141.23, rank 17 of 48 (median $132.38).
- Code 90834 pays $96.19, rank 17 of 47 (median $92.09).
- Assessment code 90791 pays $146.40, rank 19 of 44.
Community-based behavioral services
Therapeutic behavioral services are a different matter: code H2019 pays $10.81 per 15 minutes on the fee-for-service schedule, or $43.24 an hour, rank 26 of 35 against a $21.95 median. It still carries the 2025-09-01 date of the 4% reduction schedules. See Idaho behavioral health Medicaid rates.
Quarterly numerical schedules
Idaho publishes a numerical fee schedule each quarter, with version numbers. The current edition covers July to September 2026, Version 1.4. Billing teams should note the version number when confirming a rate, so they know exactly which edition a payment was based on.
Information releases
Idaho announces changes through numbered information releases (the MA series), which explain what changed and when. Reading the release alongside the schedule shows which codes moved.
Units and programs
Office codes pay per service. Behavioral health, personal care and nursing codes are billed in 15-minute units. Waiver and 1915(i) services carry their own rate schedules.
The Division of Medicaid's fee-for-service program holds 21,673 rates. Around it:
- Idaho Smiles, the statewide Medicaid dental plan run by MCNA Insurance Company, with 233 rates.
- Aged and Disabled 1915(c) Waiver (ID.1076), where attendant care code S5125 pays $6.11 per 15 minutes ($24.44 an hour), rank 19 of 31.
- Adults with Developmental Disabilities 1915(c) Waiver (ID.0076), which also sets licensed nursing code T1000 at $14.04 per 15 minutes, rank 11 of 18.
- Children's DD and Adult DD 1915(i) state plan HCBS, plus School-Based Services billed by school districts.
- A non-emergency transportation broker, Medical Transportation Management, paid a capitated monthly rate.
- MMCP and IMPlus, the dual-eligible programs, paid through one CY2026 composite capitation.
Institutional rates come from the SNF - SFY 2027 Q2 Rates, ICF - SFY 2027 Rates, Hospice Fee Schedule FY2027 and the ID DRG Calculator SFY 2027.
Idaho classifies only 8 service lines for managed care, and 3 of them bind plans to the published rate. For hospital outpatient, dental, and FQHC, RHC and clinic services, the state sets the rate plans pay. HCBS, IDD services, personal care, private duty nursing and transportation are paid directly by the state, outside managed care. No directed payment programs are on file.
The plans named are MCNA Insurance Company (Idaho Smiles), Magellan of Idaho, Medical Transportation Management, Molina Healthcare of Idaho and UnitedHealthcare Community Plan of Idaho. See the Idaho Medicaid managed care page.
Preparing for 2030
House Bill 345 (2025) moves Idaho Medicaid to comprehensive managed care, now delayed to January 1, 2030. Providers have a long runway, but the August 2026 managed care provider enrollment deadline (Information Release MA26-17) shows plan contracting already matters. Practices that rely on the published fee schedule today should start tracking which plans operate in their area and how those plans set rates in other lines.
- Personal care: code T1019 pays $5.12 per 15 minutes, or $20.48 an hour, rank 32 of 39, effective 2025-09-01. Hourly attendant care ranks 22 of 27 and sits 19.9% below the median. See Idaho home care rates.
- IDD supports: code H2016 pays $15.44 an hour, rank 27 of 29 and 55.8% below the median, one of the three lowest states (Idaho IDD rates).
- Private duty nursing: code T1002 pays $78.24 an hour, rank 9 of 43 and 42.7% above the median (Idaho private duty nursing).
- Physical therapy: code 97110 pays $96.04 an hour, exactly the national median (rank 25 of 49).
- Nursing homes: $226.90 a day, effective 2026-10-01, against a $282.59 national median.
Private duty nursing is the exception among home-based services. Nursing agencies are paid well above the median even after the 2025 reductions, while personal care agencies are not.
Idaho announces changes through numbered information releases. Recent ones on file:
- MA26-21: hospice rates for SFY 2027, effective 2026-10-01. Routine home care now pays $181.75 a day, 2.6% below the median.
- MA26-20: behavioral health respite services update, effective 2026-09-08.
- MA26-18: updated terms in the nursing facility provider agreement, effective 2026-09-07.
- MA26-16 and MA26-11: home health rates for SFY 2027 and amended residential habilitation rates, effective 2026-07-01.
- MA26-14 and MA26-15: ambulance mileage claims and removal of the service animal benefit, both effective 2026-07-01.
- MA26-19: clarification on claim submission expectations.
Ambulance providers should check that mileage claims follow MA26-14. Residential habilitation and home health agencies should confirm their billing uses the SFY 2027 rates. The next numerical fee schedule edition is due for the October quarter.
| State | 99213 | 97153 (per 15 min) | T1019 (per 15 min) |
|---|---|---|---|
| Idaho | $86.12 | not listed | $5.12 |
| Montana | $133.81 | $11.36 | $9.23 |
| Utah | $122.78 | $19.67 | $7.95 |
| Wyoming | $79.31 | $12.30 | $14.02 |
| Nevada | $47.47 | $13.01 | $4.39 |
| Colorado | $73.99 | $17.20 | $7.22 |
Idaho sits mid-pack on the office visit: well behind Montana, Utah and New Mexico ($128.92), ahead of Wyoming, Colorado, Arizona ($48.68) and Nevada. On personal care, only Nevada pays less among its neighbors.
Idaho's rate history on file runs back to 2008. Physician and behavioral health codes carry 2026-07-01 dates from the July numerical schedule; personal care, H2019 and private duty nursing carry 2025-09-01 dates from the 4% reduction schedules; hospice and nursing homes carry 2026-10-01 dates. The mix of dates is itself a guide to which lines have been revisited recently.
Budgeting
Use the current quarterly edition for professional services and the program schedule for waiver services. Convert 15-minute units to hourly figures when comparing against wages.
Contract negotiation
Most services are paid directly by the state today, so negotiation matters mainly for the behavioral health and dental plans. Prepare for plan contracting ahead of 2030.
Benchmarking
All 23,716 current Idaho rates and their history are on the pricing page.
Rates are compiled from official Idaho Medicaid publications, and each rate links to its source document. Named sources include the Idaho Medicaid Numerical Fee Schedule July to September 2026 (Version: 1.4), the Magellan Idaho Behavioral Health Plan Rates, the 4% Provider Rate Reductions Fee Schedules, the MCNA reimbursement exhibit, the SNF - SFY 2027 Q2 Rates, the ICF - SFY 2027 Rates, the Hospice Fee Schedule FY2027 and the ID DRG Calculator SFY 2027. Our methodology explains how ranks are compiled.