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New Jersey Medicaid reimbursement rates

105,350 current fee-for-service and managed-care rates from New Jersey Medicaid, across 116 services and 8 programs, normalized by code, provider level and unit. Each links to one of 257 official source documents.

Last retrieved 2026-10-02. History back to 2011-07-01.

Current rates
105,350
Services
116
Programs
8
Lines with a plan rule
11of 15 service lines

By industry

New Jersey rates by service

The median current rate for each service, like-for-like by unit. Follow a service to compare it with every other state.

ServiceLineMedian rateUnitPer hourVariants
ABA assessment by a behavior analystABA / autism services$25.0015 min$100.003
ABA assessment support by a technicianABA / autism services$11.2015 min$44.803
ABA assessment with 2+ technicians (severe behavior)ABA / autism services$25.0015 min$100.003
ABA parent and caregiver trainingABA / autism services$25.0015 min$100.003
ABA therapy with 2+ technicians (severe behavior)ABA / autism services$16.4015 min$65.603
ABA therapy with plan changes by an analystABA / autism services$21.2515 min$85.003
Group ABA parent training (several families)ABA / autism services$12.4015 min$49.603
Group ABA therapy led by a technicianABA / autism services$4.8015 min$19.203
Group ABA therapy led by an analystABA / autism services$5.6015 min$22.403
One-on-one ABA therapy by a technicianABA / autism services$15.0015 min$60.003
Assertive Community Treatment (ACT) teamBehavioral health$1,651.59Monthly rate—3
Behavioral health services (fee schedule)Behavioral health$39.79day$73.76674
Community-based wraparound servicesBehavioral health$12.3815 min$49.528
Comprehensive community support servicesBehavioral health$27.7215 min$110.8855
Continuing day treatment for adultsBehavioral health$17.91hour$17.912
Employment and education support (BH HCBS)Behavioral health$24.3015 min$97.2016
Hospital outpatient mental health program servicesBehavioral health$62.4230 min$133.8121
Mental health assessment (non-physician)Behavioral health$91.49——12
Mental health service plan developmentBehavioral health$13.67——4
Outpatient psychotherapy and diagnostic evaluationBehavioral health$81.62One Evaluation$143.54917
Psychiatric partial hospitalizationBehavioral health$17.91hour$41.436
Skills training and developmentBehavioral health$15.7115 min$62.8416
Supervised living or host home (adults with mental illness)Behavioral health$224.77day—24
Therapeutic behavioral servicesBehavioral health$12.7515 min$51.0048
FQHC / RHC visit (PPS or APM rate)Clinics (FQHC/RHC)$245.27encounter—41
Dental servicesDental$149.00——1623
Durable medical equipmentEquipment & supplies$72.60—$45.581969
Enteral and parenteral nutritionEquipment & supplies$25.28day—66
Medical suppliesEquipment & supplies$7.46——793
Orthotics and prostheticsEquipment & supplies$363.12—$83.763324
Adult day health (medical model)Other home & community services$95.31day—2
Adult day servicesOther home & community services$44.00——18
Assisted living / alternative living servicesOther home & community services$91.10——251
Case management / support coordinationOther home & community services$57.1315 min$152.36101
Community transition (moving out of an institution)Other home & community services$2,502.00——24
Emergency response system installationOther home & community services$78.00——4
Emergency response system monitoringOther home & community services$75.00month—15
Financial management services (self-direction)Other home & community services$568.98Per-Member, Per-Month—5
Home modifications (accessibility)Other home & community services$5,000.00——4
Home-delivered mealsOther home & community services$16.50——4
Interpreter servicesOther home & community services$11.7115 min$46.8218
Nursing assessmentOther home & community services$51.00——20
Prescribed pediatric extended care (medical day care)Other home & community services$299.43hour$299.432
Respite care (daily)Other home & community services$250.00day—31
Respite care (hourly)Other home & community services$160.0015 min$1,161.80106
Respite in a facility (daily)Other home & community services$7.08day—12
Self-direction coaching / supports brokerOther home & community services$10.0515 min$40.2013
Service planning meetingOther home & community services$249.24——12
Home health aide visitHome health$14.10——48
Home health nurse visit (RN or LPN)Home health$76.87——40
Home health occupational therapyHome health$65.45——46
Home health physical therapyHome health$66.79——42
Home health speech therapyHome health$56.49——42
Home health visit (other or unspecified)Home health$59.22——40
Hospice continuous home care (hourly)Hospice$1,812.67—$1,888.3326
Hospice end-of-life visit add-on (per hour)Hospice$73.0815 min$292.3220
Hospice general inpatient care (daily)Hospice$1,256.46day—20
Hospice inpatient respite (daily)Hospice$606.59day—26
Hospice routine home care (daily)Hospice$220.42day—40
Hospital day awaiting discharge (alternate level of care)Hospital inpatient$267.77——1
Inpatient DRG pricing input (outlier, cost ratio, stay)Hospital inpatient$0.1835CCR—66
Inpatient DRG relative weightHospital inpatient$2.49weight—1336
Inpatient hospital stay (DRG base rate)Hospital inpatient$6,842.75——132
Inpatient hospital stay (per diem)Hospital inpatient$1,443.00day—43
Inpatient rate add-on (education, wage, directed payment)Hospital inpatient$0.00Percentage (column heading)—260
Outpatient hospital (percent of charges or cost)Hospital outpatient$14.99Ratio (printed as %)—106
Surgery center facility fee (per procedure)Hospital outpatient$811.85——3583
Behavior support services (disability waiver)IDD services$15.2315 min$60.922
Community integration / community access (IDD)IDD services$5.7415 min$22.9613
Day habilitation / day program (IDD)IDD services$11.2815 min$34.0098
Day treatment for people with I/DD (clinic)IDD services$83.88——8
Employment explorationIDD services$16.3615 min$65.442
In-home and community living supports (IDD)IDD services$11.0415 min$44.164
Prevocational servicesIDD services$8.9915 min$12.5940
Residential habilitation / group home supportsIDD services$552.16day—12
Supported employment (job coaching)IDD services$8.8315 min$28.9239
Transitional / crisis stabilization living supportsIDD services$76.00——3
Clinical lab testsLab & pathology$16.66——9385
Nursing home stay (daily rate)Nursing facility$282.49——231
Diabetes prevention program session or milestone paymentOther$40.00——4
Directed payment program total (CMS-approved amount)Other$6,832,530.00up to $18,207,438—3
Directed payment uniform increase (required MCO uplift)Other$15.00visit—4
Directed payment: plan payment level (% of benchmark)Other$42.51% of Medicare (named in Q27 methodology text)—11
Home health aide or nurse aide care (hourly)Personal care & attendant$25.76hour$26.6812
Homemaker / housekeeping helpPersonal care & attendant$15.5015 min$62.0018
Personal care / attendant care (hourly)Personal care & attendant$24.09hour$39.0041
Pharmacy dispensing feePharmacy$8.00——4
Physician-administered drugs (J-codes)Pharmacy$11.33——3837
Nurse shadowing / home care trainingPrivate duty nursing$40.00——1
Private duty nursing (hourly shifts)Private duty nursing$50.00hour$15.7559
Waiver nursing (RN or LPN, by the 15 minutes)Private duty nursing$3,510.0015 min$14,040.0016
Anesthesia base units (per procedure)Physician & professional$5.00base unit—6109
Anesthesia conversion factorPhysician & professional$9.30base unit—24548
Physician and practitioner services (fee schedule)Physician & professional$205.12—$58.3636388
Imaging and radiologyRadiology$39.85——7473
Cognitive rehabilitation therapyTherapy (PT/OT/speech)$11.2015 min$44.809
Nutrition counseling (dietitian)Therapy (PT/OT/speech)$22.5315 min$90.1212
Occupational therapyTherapy (PT/OT/speech)$3,510.0015 min$14,040.0018
Occupational therapy evaluationTherapy (PT/OT/speech)$50.88——24
Orthotic and prosthetic fitting and trainingTherapy (PT/OT/speech)$23.6815 min$94.724
Physical therapyTherapy (PT/OT/speech)$3,510.0015 min$14,040.0030
Physical therapy evaluationTherapy (PT/OT/speech)$49.50——24
Speech-generating device evaluationTherapy (PT/OT/speech)$3,510.00——12
Speech-generating device therapyTherapy (PT/OT/speech)$3,510.00——12
Speech-language evaluationTherapy (PT/OT/speech)$3,510.00——48
Speech-language therapyTherapy (PT/OT/speech)$8.6715 min$69.3636
Swallowing and feeding evaluationTherapy (PT/OT/speech)$3,510.00——12
Swallowing and feeding therapyTherapy (PT/OT/speech)$3,510.00——12
Air ambulance transportTransportation$2,676.55——2
Ambulance extras (waiting time, extra attendant, neonatal)Transportation$12.00——4
Ambulance mileageTransportation$2.83mile—12
Ground ambulance transportTransportation$58.00——10
Non-emergency medical transportation (NEMT)Transportation$10.00one-way$95.2038
Waiver transportation (to community activities)Transportation$5.00mile—5
Eyeglasses and contact lensesVision & hearing$71.97——394
Hearing aids and hearing servicesVision & hearing$175.00——56

Most-compared billing codes in New Jersey

Where New Jersey ranks among states for codes published widely. Rank 1 = highest rate.

CodeServiceNew JerseyAll-state medianRank
10004Physician and practitioner services (fee schedule)$9.30per base unit$35.5219 of 19
10005Physician and practitioner services (fee schedule)$9.30per base unit$60.6319 of 19
10006Physician and practitioner services (fee schedule)$9.30per base unit$39.9019 of 19
10007Physician and practitioner services (fee schedule)$9.30per base unit$76.7419 of 19
10008Physician and practitioner services (fee schedule)$9.30per base unit$46.9419 of 19
10009Physician and practitioner services (fee schedule)$9.30per base unit$93.0319 of 19
10010Physician and practitioner services (fee schedule)$9.30per base unit$65.3219 of 19
10021Physician and practitioner services (fee schedule)$23.10$49.7719 of 19
10030Physician and practitioner services (fee schedule)$50.27$119.4318 of 19
10035Physician and practitioner services (fee schedule)$30.21$70.2619 of 19
10036Physician and practitioner services (fee schedule)$15.63$35.4119 of 19
10060Physician and practitioner services (fee schedule)$55.87$76.1616 of 19
10061Physician and practitioner services (fee schedule)$9.30per base unit$129.1619 of 19
10080Physician and practitioner services (fee schedule)$9.30per base unit$78.7319 of 19
10081Physician and practitioner services (fee schedule)$9.30per base unit$127.8619 of 19
10120Physician and practitioner services (fee schedule)$68.54$77.4413 of 19
10121Physician and practitioner services (fee schedule)$9.30per base unit$135.2919 of 19
10140Physician and practitioner services (fee schedule)$75.80$86.4513 of 19
10160Physician and practitioner services (fee schedule)$57.18$69.5213 of 19
10180Physician and practitioner services (fee schedule)$9.30per base unit$148.1019 of 19
11000Physician and practitioner services (fee schedule)$25.65$24.528 of 19
11001Physician and practitioner services (fee schedule)$13.80$12.368 of 19
11004Physician and practitioner services (fee schedule)$9.30per base unit$437.2119 of 19
11005Physician and practitioner services (fee schedule)$9.30per base unit$573.0219 of 19
11006Physician and practitioner services (fee schedule)$9.30per base unit$542.1619 of 19
11008Physician and practitioner services (fee schedule)$122.89$206.5617 of 19
11010Physician and practitioner services (fee schedule)$9.30per base unit$225.2419 of 19
11011Physician and practitioner services (fee schedule)$9.30per base unit$229.4619 of 19
11012Physician and practitioner services (fee schedule)$9.30per base unit$326.2619 of 19
11042Physician and practitioner services (fee schedule)$9.30per base unit$50.8019 of 19
11043Physician and practitioner services (fee schedule)$19.95$134.2119 of 19
11044Physician and practitioner services (fee schedule)$9.30per base unit$182.1219 of 19
11055Physician and practitioner services (fee schedule)$27.51$14.804 of 19
11056Physician and practitioner services (fee schedule)$34.77$20.384 of 19
11057Physician and practitioner services (fee schedule)$38.73$26.136 of 19
11102Physician and practitioner services (fee schedule)$9.30per base unit$32.2319 of 19
11103Physician and practitioner services (fee schedule)$9.30per base unit$18.6519 of 19
11104Physician and practitioner services (fee schedule)$9.30per base unit$40.4319 of 19
11105Physician and practitioner services (fee schedule)$9.30per base unit$22.0519 of 19
11106Physician and practitioner services (fee schedule)$9.30per base unit$49.2119 of 19

Managed care in New Jersey

62 plans on record, 17 state-directed payment records.

Who sets the rate, line by line →

Recent rate changes and notices

Frequently asked questions

Where does New Jersey publish its Medicaid fee schedules?

New Jersey publishes rates across 257 official documents (fee schedules, rate notices and bulletins). Every rate on this page links to its source document.

How many Medicaid rates does New Jersey publish?

105,350 rates are current across 116 services and 8 programs, with 247,209 versions on record since 2011-07-01.

Do New Jersey Medicaid managed-care plans pay the fee schedule?

For 11 of 15 service lines, plan contracts or state law set a rule plans must follow (a floor, a state-set rate or a required pass-through). For the rest, plans negotiate. See the managed-care page for each line's rule and citation.

Other states

Your New Jersey rate cardYour codes, what New Jersey pays, what plans must pay, and every change in 2026.
Medicaid rates by state