Vermont Medicaid reimbursement rates
34,243 current fee-for-service and managed-care rates from Vermont Medicaid, across 104 services and 8 programs, normalized by code, provider level and unit. Each links to one of 26 official source documents.
Last retrieved 2026-10-05. History back to 1990-06-28.
- Current rates
- 34,243
- Services
- 104
- Programs
- 8
- Lines with a plan rule
- 0of 21 service lines
By industry
Applied behavior analysis (ABA)Vermont rates, labor costs and changesBehavioral healthVermont rates, labor costs and changesHome healthVermont rates, labor costs and changesHome care & personal careVermont rates, labor costs and changesPrivate duty nursingVermont rates, labor costs and changesSkilled nursing facilitiesVermont rates, labor costs and changesHospiceVermont rates, labor costs and changesIntellectual & developmental disabilitiesVermont rates, labor costs and changesOutpatient therapy (PT, OT, speech)Vermont rates, labor costs and changes
Vermont 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.
| Service | Line | Median rate | Unit | Per hour | Variants |
|---|---|---|---|---|---|
| ABA assessment by a behavior analyst | ABA / autism services | $65.80 | 15 min | $263.20 | 1 |
| ABA assessment support by a technician | ABA / autism services | $30.00 | 15 min | $120.00 | 1 |
| ABA assessment with 2+ technicians (severe behavior) | ABA / autism services | $52.00 | 15 min | $208.00 | 1 |
| ABA parent and caregiver training | ABA / autism services | $17.00 | 15 min | $68.00 | 6 |
| ABA therapy with 2+ technicians (severe behavior) | ABA / autism services | $26.00 | 15 min | $104.00 | 1 |
| ABA therapy with plan changes by an analyst | ABA / autism services | $49.35 | 15 min | $197.40 | 1 |
| Group ABA parent training (several families) | ABA / autism services | $26.00 | 15 min | $85.56 | 2 |
| Group ABA therapy led by a technician | ABA / autism services | $7.50 | 15 min | $30.00 | 1 |
| Group ABA therapy led by an analyst | ABA / autism services | $16.45 | 15 min | $65.80 | 1 |
| One-on-one ABA therapy by a technician | ABA / autism services | $15.00 | 15 min | $60.00 | 1 |
| Behavioral health services (fee schedule) | Behavioral health | $92.00 | — | $122.48 | 84 |
| Community-based wraparound services | Behavioral health | $356.79 | day | — | 1 |
| Crisis intervention (behavioral health) | Behavioral health | $50.14 | 15 min. | — | 1 |
| Mental health counseling | Behavioral health | $21.02 | 15 min | $84.06 | 2 |
| Mobile and telephone crisis response | Behavioral health | $447.26 | dispatch | — | 5 |
| Opioid treatment program monthly (PMPM) bundle | Behavioral health | $546.81 | month | — | 2 |
| Outpatient psychotherapy and diagnostic evaluation | Behavioral health | $89.18 | hour | $118.80 | 362 |
| Psychological and developmental testing | Behavioral health | $54.50 | hour | — | 4 |
| Skills training and development | Behavioral health | $10.34 | 15 min | $41.34 | 2 |
| Therapeutic behavioral services | Behavioral health | $21.94 | 15 min | $87.76 | 2 |
| Therapeutic behavioral services (daily rate) | Behavioral health | $500.00 | day | — | 1 |
| FQHC/RHC encounter rate add-on | Clinics (FQHC/RHC) | $23.00 | — | — | 3 |
| Dental services | Dental | $256.13 | — | — | 306 |
| Durable medical equipment | Equipment & supplies | $328.76 | — | $59.88 | 627 |
| Enteral and parenteral nutrition | Equipment & supplies | $14.75 | day | — | 35 |
| Medical supplies | Equipment & supplies | $8.63 | — | — | 448 |
| Orthotics and prosthetics | Equipment & supplies | $477.89 | — | $117.54 | 867 |
| Adult day health (medical model) | Other home & community services | $6.64 | 15 min | $26.56 | 1 |
| Adult day services | Other home & community services | $6.61 | 15 min | $26.56 | 4 |
| Adult foster care | Other home & community services | $140.73 | day | — | 12 |
| Assisted living / alternative living services | Other home & community services | $85.90 | 1 day | — | 12 |
| Brain injury rehabilitation services (Medicaid program) | Other home & community services | $6.64 | 15 min | $26.54 | 2 |
| Case management / support coordination | Other home & community services | $23.68 | — | $77.90 | 28 |
| Community integration (older adults / disability waivers) | Other home & community services | $96.93 | 1 day | — | 2 |
| Community transition (moving out of an institution) | Other home & community services | $40,000.00 | — | — | 10 |
| Emergency response system installation | Other home & community services | $72.15 | — | — | 1 |
| Emergency response system monitoring | Other home & community services | $40.32 | month | — | 1 |
| Employment supports (HCBS, non-IDD) | Other home & community services | $6.64 | 15 min | $26.54 | 2 |
| Financial management services (self-direction) | Other home & community services | $88.00 | month | — | 10 |
| HCBS cost cap or rate limit | Other home & community services | $4,269.88 | 1 Unit = Lifetime | — | 4 |
| HCBS waiver service (other) | Other home & community services | $646.27 | 1 day | — | 2 |
| Interpreter services | Other home & community services | $17.50 | 15 min | $70.00 | 2 |
| Nursing assessment | Other home & community services | $100.55 | — | — | 5 |
| Prescribed pediatric extended care (medical day care) | Other home & community services | $821.50 | day | $183.00 | 2 |
| Residential care home (daily rate incl. room and board) | Other home & community services | $89.83 | 1 day | — | 1 |
| Respite care (daily) | Other home & community services | $338.56 | day | — | 13 |
| Respite care (hourly) | Other home & community services | $8.32 | 15 min | $33.12 | 17 |
| Respite in a facility (daily) | Other home & community services | $120.11 | 1 day | — | 1 |
| Self-directed (consumer choices) budget-calculation rate | Other home & community services | $1,735.70 | month | — | 2 |
| Self-direction coaching / supports broker | Other home & community services | $29.07 | 15 min | $72.56 | 6 |
| Service planning meeting | Other home & community services | $16.23 | — | $63.24 | 4 |
| Vehicle modifications | Other home & community services | $7,002.45 | 1 Unit=1 encounter | — | 1 |
| Home health agency daily rate / overhead | Home health | $128.38 | day | — | 1 |
| Home health speech therapy | Home health | $84.00 | day | — | 4 |
| Inpatient DRG pricing input (outlier, cost ratio, stay) | Hospital inpatient | $13,545.00 | — | — | 12 |
| Inpatient DRG relative weight | Hospital inpatient | $1.51 | — | — | 766 |
| Inpatient hospital stay (DRG base rate) | Hospital inpatient | $9,755.00 | — | — | 7 |
| Inpatient psychiatric stay (per day) | Hospital inpatient | $1,345.00 | day | — | 1 |
| Inpatient rate add-on (education, wage, directed payment) | Hospital inpatient | $250.00 | day | — | 2 |
| Outpatient hospital services (fee schedule) | Hospital outpatient | $377.01 | — | $105.79 | 10723 |
| Outpatient payment adjustment factor | Hospital outpatient | $1.00 | — | — | 19 |
| In-home and community living supports (IDD) | IDD services | $6.60 | — | — | 1 |
| Intensive behavioral residential supports | IDD services | $25.04 | 15 min | $100.14 | 2 |
| Prevocational services | IDD services | $18.38 | hour | $18.38 | 1 |
| Supported employment (job coaching) | IDD services | $17.42 | 15 min | $69.68 | 5 |
| Supported employment follow-along | IDD services | $17.61 | 15 min | $70.42 | 2 |
| Clinical lab tests | Lab & pathology | $19.80 | — | — | 2127 |
| Nursing home stay (daily rate) | Nursing facility | $412.92 | day | — | 32 |
| Swing-bed stay (hospital bed used for nursing-home care) | Nursing facility | $413.58 | day | — | 1 |
| Dialysis facility composite rate (per treatment) | Other | $157.76 | day | — | 1 |
| Companion care | Personal care & attendant | $12.98 | 15 min | $51.40 | 7 |
| Home care worker wage scale (collective bargaining) | Personal care & attendant | $18.10 | hour | $32.80 | 54 |
| Home health aide or nurse aide care (hourly) | Personal care & attendant | $12.98 | hour | $18.08 | 6 |
| Homemaker / housekeeping help | Personal care & attendant | $12.98 | 15 min | $51.92 | 1 |
| Personal care (daily rate) | Personal care & attendant | $379.40 | day | — | 5 |
| Personal care / attendant care (hourly) | Personal care & attendant | $12.68 | 15 min | $50.00 | 6 |
| Physician-administered drugs (J-codes) | Pharmacy | $14.11 | — | — | 897 |
| Nurse shadowing / home care training | Private duty nursing | $12.00 | — | — | 6 |
| Private duty nursing (hourly shifts) | Private duty nursing | $16.75 | 15 min | $67.00 | 8 |
| Waiver nursing (RN or LPN, by the 15 minutes) | Private duty nursing | $22.34 | 15 min | $89.34 | 4 |
| Physician and practitioner services (fee schedule) | Physician & professional | $380.98 | — | $93.36 | 13786 |
| Practitioner payment adjustment (percent or set amount) | Physician & professional | $50.00 | — | — | 32 |
| Imaging and radiology | Radiology | $70.93 | — | — | 2380 |
| Activity therapy | Therapy (PT/OT/speech) | $10.18 | 15 min | $40.72 | 1 |
| Cognitive rehabilitation therapy | Therapy (PT/OT/speech) | $17.04 | 15 min | $68.14 | 4 |
| Nutrition counseling (dietitian) | Therapy (PT/OT/speech) | $28.86 | 15 min | $97.86 | 6 |
| Occupational therapy | Therapy (PT/OT/speech) | $29.57 | 15 min | $118.28 | 10 |
| Occupational therapy evaluation | Therapy (PT/OT/speech) | $85.00 | — | — | 32 |
| Orthotic and prosthetic fitting and training | Therapy (PT/OT/speech) | $38.91 | 15 min | $155.64 | 18 |
| Physical therapy | Therapy (PT/OT/speech) | $26.03 | 15 min | $104.10 | 16 |
| Physical therapy evaluation | Therapy (PT/OT/speech) | $83.02 | — | — | 32 |
| Speech-generating device evaluation | Therapy (PT/OT/speech) | $103.67 | — | — | 8 |
| Speech-generating device therapy | Therapy (PT/OT/speech) | $86.70 | — | — | 8 |
| Speech-language evaluation | Therapy (PT/OT/speech) | $103.45 | — | — | 8 |
| Speech-language therapy | Therapy (PT/OT/speech) | $64.34 | — | — | 8 |
| Swallowing and feeding evaluation | Therapy (PT/OT/speech) | $60.24 | — | — | 8 |
| Swallowing and feeding therapy | Therapy (PT/OT/speech) | $71.14 | — | — | 8 |
| Air ambulance transport | Transportation | $3,890.69 | — | — | 2 |
| Ambulance extras (waiting time, extra attendant, neonatal) | Transportation | $0.35 | — | — | 1 |
| Ambulance mileage | Transportation | $10.23 | mile | — | 3 |
| Ground ambulance transport | Transportation | $270.28 | mile | — | 13 |
| Non-emergency medical transportation (NEMT) | Transportation | $11.88 | mile | — | 12 |
| Eyeglasses and contact lenses | Vision & hearing | $10.00 | — | — | 196 |
| Hearing aids and hearing services | Vision & hearing | $450.00 | — | — | 37 |
Most-compared billing codes in Vermont
Where Vermont ranks among states for codes published widely. Rank 1 = highest rate.
| Code | Service | Vermont | All-state median | Rank |
|---|---|---|---|---|
| 10005 | Physician and practitioner services (fee schedule) | $109.69 | $85.55 | 13 of 48 |
| 10006 | Physician and practitioner services (fee schedule) | $49.39 | $45.64 | 16 of 48 |
| 10007 | Physician and practitioner services (fee schedule) | $288.08 | $186.96 | 7 of 48 |
| 10008 | Physician and practitioner services (fee schedule) | $117.63 | $92.51 | 15 of 48 |
| 10009 | Physician and practitioner services (fee schedule) | $346.65 | $273.41 | 15 of 48 |
| 10010 | Physician and practitioner services (fee schedule) | $196.33 | $153.30 | 15 of 48 |
| 10021 | Physician and practitioner services (fee schedule) | $83.80 | $71.68 | 14 of 48 |
| 10030 | Physician and practitioner services (fee schedule) | $521.93 | $382.62 | 13 of 48 |
| 10060 | Physician and practitioner services (fee schedule) | $107.14 | $88.74 | 12 of 48 |
| 10061 | Physician and practitioner services (fee schedule) | $181.88 | $153.30 | 14 of 48 |
| 10080 | Physician and practitioner services (fee schedule) | $225.66 | $129.47 | 9 of 48 |
| 10081 | Physician and practitioner services (fee schedule) | $315.43 | $200.51 | 9 of 48 |
| 10120 | Physician and practitioner services (fee schedule) | $131.35 | $98.41 | 9 of 48 |
| 10121 | Physician and practitioner services (fee schedule) | $227.89 | $171.22 | 11 of 48 |
| 10140 | Physician and practitioner services (fee schedule) | $144.80 | $109.79 | 10 of 48 |
| 10160 | Physician and practitioner services (fee schedule) | $109.27 | $86.10 | 11 of 48 |
| 10180 | Physician and practitioner services (fee schedule) | $237.30 | $181.20 | 10 of 48 |
| 11000 | Physician and practitioner services (fee schedule) | $49.39 | $37.55 | 11 of 48 |
| 11001 | Physician and practitioner services (fee schedule) | $22.50 | $17.78 | 13 of 48 |
| 11004 | Physician and practitioner services (fee schedule) | $397.88 | $437.24 | 32 of 48 |
| 11005 | Physician and practitioner services (fee schedule) | $538.54 | $593.30 | 31 of 48 |
| 11006 | Physician and practitioner services (fee schedule) | $488.99 | $545.22 | 32 of 48 |
| 11008 | Physician and practitioner services (fee schedule) | $189.68 | $210.47 | 32 of 48 |
| 11010 | Physician and practitioner services (fee schedule) | $387.20 | $279.22 | 11 of 48 |
| 11011 | Physician and practitioner services (fee schedule) | $442.28 | $321.34 | 10 of 48 |
| 11012 | Physician and practitioner services (fee schedule) | $563.48 | $431.82 | 11 of 48 |
| 11042 | Physician and practitioner services (fee schedule) | $110.83 | $82.72 | 11 of 48 |
| 11043 | Physician and practitioner services (fee schedule) | $197.33 | $165.09 | 14 of 48 |
| 11044 | Physician and practitioner services (fee schedule) | $262.73 | $227.02 | 14 of 48 |
| 11055 | Physician and practitioner services (fee schedule) | $59.02 | $38.32 | 10 of 48 |
| 11056 | Physician and practitioner services (fee schedule) | $68.22 | $45.25 | 10 of 48 |
| 11057 | Physician and practitioner services (fee schedule) | $74.59 | $50.83 | 10 of 48 |
| 11102 | Physician and practitioner services (fee schedule) | $80.11 | $70.00 | 16 of 48 |
| 11103 | Physician and practitioner services (fee schedule) | $40.76 | $36.04 | 14 of 48 |
| 11104 | Physician and practitioner services (fee schedule) | $101.49 | $82.45 | 14 of 48 |
| 11105 | Physician and practitioner services (fee schedule) | $50.25 | $42.01 | 14 of 48 |
| 11106 | Physician and practitioner services (fee schedule) | $126.55 | $100.59 | 14 of 48 |
| 11107 | Physician and practitioner services (fee schedule) | $59.16 | $48.97 | 14 of 48 |
| 11300 | Physician and practitioner services (fee schedule) | $80.96 | $49.39 | 11 of 48 |
| 11301 | Physician and practitioner services (fee schedule) | $97.37 | $63.36 | 10 of 48 |
Managed care in Vermont
3 plans on record, 0 state-directed payment records, 15 published capitation cells.
Who sets the rate, line by line →Recent rate changes and notices
Frequently asked questions
Where does Vermont publish its Medicaid fee schedules?
Vermont publishes rates across 26 official documents (fee schedules, rate notices and bulletins). Every rate on this page links to its source document.
How many Medicaid rates does Vermont publish?
34,243 rates are current across 104 services and 8 programs, with 95,228 versions on record since 1990-06-28.
Do Vermont Medicaid managed-care plans pay the fee schedule?
For 0 of 21 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.
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Your Vermont rate cardYour codes, what Vermont pays, what plans must pay, and every change in 2026.