The North Dakota Medicaid fee schedule pays $105.14 for code 99213, a level-3 return office visit, effective July 1, 2026. That is sixth of 46 states, well above the $75.27 national median and above Medicare's $93.41. North Dakota ranks in the top ten on nearly every common physician, therapy and behavioral health code, and it raised rates twice in 2026. The clear exception is technician-level ABA.
MedicaidRate holds 19,715 current North Dakota Medicaid reimbursement rates across 101 service categories, compiled from 41 official ND Medicaid publications. Our history for North Dakota begins in 2023, so year-over-year comparisons cover the most recent rate cycles. Every rate links to its source; see our methodology.
ND Medicaid fee schedules and programs
The core document is the ND Medicaid Professional (General) Services Fee Schedule, with data updated as of July 1, 2026. Alongside it:
- ND Medicaid DME and Supplies Fee Schedule and ND Medicaid Dental Services Fee Schedule, both updated July 1, 2026
- ND Medicaid Basic Care Fee Schedule, effective July 1, 2026
- ND PDPM Case Mix Values, the classifications and case mix index values used for nursing facilities
- DD Rate Matrix - Fully Loaded Hour Value, known as "The Brick", which prices developmental disability services
Nursing facilities are unusually prominent in the dataset, with 1,880 rates, behind only physician services (7,162) and hospital outpatient (4,059).
Of 19,715 rates, 19,436 belong to North Dakota Medicaid (fee-for-service). The rest are home and community programs: the Traditional IID/DD HCBS Waiver (ND.0037), Adults and Aging Qualified Service Provider (QSP) rates, the 1915(i) behavioral health state plan option, the aged and physically disabled waiver (ND.0273), and SPED / Expanded SPED, a state-funded program that is not Medicaid.
North Dakota Medicaid rates for common codes
| Code | Service | ND rate | National median | Rank |
|---|---|---|---|---|
| 99213 | Return visit, level 3 | $105.14 | $75.27 | 6 of 46 |
| 99214 | Return visit, level 4 | $149.45 | $108.69 | 6 of 46 |
| 90837 | Psychotherapy, one hour | $187.37 | $132.38 | 7 of 48 |
| 92507 | Speech therapy session | $85.24 | $62.12 | 6 of 44 |
| A0427 | ALS ambulance | $626.51 | $387.24 | 5 of 44 |
| 97153 | ABA by technician, 15 min | $10.81 | $15.86 | 38 of 42 |
The consistency is striking. Every office visit code ranks between fifth and eighth, and each sits above Medicare: 99215 pays $211.78 against $188.22, and new-patient 99204 pays $194.13 against $172.60. Emergency department code 99285 pays $181.74 (sixth of 48), and the adult preventive visit under 99396 pays $142.31 (fifth of 46).
Behavioral health follows the same pattern. Code 90834 pays $127.67 (eighth of 47) and 90791 pays $194.50 (sixth of 44), both above Medicare. Speech therapy under 92507 pays $85.24, above Medicare's $75.96.
For ambulance services, the $626.51 ALS rate is fifth in the nation.
ABA therapy: high for analysts, low for technicians
North Dakota prices ABA unevenly. Technician-delivered 97153 pays $43.24 an hour, 38th of 42 states and 31.8% below the median. Analyst-directed 97155 and assessment code 97151 both pay $31.76 per 15 minutes ($127.04 an hour), ranking 13th and 18th. An ABA provider whose model leans on technician hours will find North Dakota much less attractive than the physician rankings suggest. See the North Dakota ABA Medicaid rates page.
Managed care in North Dakota
North Dakota's published rates are overwhelmingly fee-for-service. Only two service lines have a managed-care rule on record, and both are the same: for hospital inpatient and hospital outpatient services, the state sets the rate plans pay. No state directed payment programs are on record.
Named arrangements in state documents include Blue Cross Blue Shield of North Dakota, Northland PACE, and Primary Care Case Management (PCCM). SPA ND-26-0010, approved by CMS on August 13, 2026, revised the PACE rate development methodology effective July 1, 2026. See the North Dakota managed care page.
Industry flagship rates in North Dakota
- Physical therapy: 97110 pays $129.16 an hour, fifth of 49 and 34.5% above the median, at 112% of Medicare. See North Dakota therapy Medicaid rates.
- Personal care: agency T1019 pays $38.36 an hour, sixth of 27 and 25.7% above the median. See North Dakota home care rates.
- IDD: in-home supports under S5125 pay $41.72 an hour, 10th of 29 and 19.5% above the median.
- Skilled nursing: $393.14 a day, effective January 1, 2026.
- Home health: $77.36 per day under T1030.
Recent North Dakota Medicaid rate changes
Both 2026 rate cycles, January 1 and July 1, were increases:
- State plan changes for January 1, 2026: a 3.2% increase.
- State plan changes and fee schedules for July 1, 2026: a 2.0% increase, posted to the website July 18, 2026.
- Therapy policy update, effective February 1, 2026, revising physical, occupational and speech therapy policies, with a January 28 clarification on code 92507 modifiers.
- EAPG payment update on the JW modifier for outpatient hospital claims.
- IID/DD HCBS waiver amendment, posted for public notice January 26, 2026.
North Dakota compared with nearby states
| State | 99213 | 97153 (15 min) | T1019 (15 min) |
|---|---|---|---|
| North Dakota | $105.14 | $10.81 | $6.98 |
| South Dakota | $89.93 | $21.73 | $11.17 |
| Nebraska | $85.69 | $18.70 | n/a |
| Minnesota | $73.99 | $20.17 | $5.46 |
| Iowa | $43.23 | $28.59 | $10.50 |
North Dakota pays the most in the region for an office visit, ahead of South Dakota and Nebraska and far ahead of Iowa. For technician ABA, it pays the least of these states. Base T1019 personal care at $6.98 per unit trails South Dakota and Iowa, though the agency T1019 rate of $9.59 ranks sixth nationally.
Updated 2026-10-05