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Wisconsin Medicaid reimbursement rates

83,088 current fee-for-service and managed-care rates from Wisconsin Medicaid, across 117 services and 12 programs, normalized by code, provider level and unit. Each links to one of 98 official source documents. Wisconsin pays the highest rate of any state we cover for 11001.

Last retrieved 2026-10-05. History back to 1900-01-01.

Current rates
83,088
Services
117
Programs
12
Lines with a plan rule
7of 21 service lines

By industry

Wisconsin 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$25.9015 min$103.602
ABA assessment support by a technicianABA / autism services$22.9315 min$91.722
ABA parent and caregiver trainingABA / autism services$28.0315 min$112.123
ABA therapy with 2+ technicians (severe behavior)ABA / autism services$18.3415 min$73.362
ABA therapy with plan changes by an analystABA / autism services$22.9315 min$91.722
Group ABA therapy led by a technicianABA / autism services$6.3915 min$25.567
Group ABA therapy led by an analystABA / autism services$6.3915 min$25.566
One-on-one ABA therapy by a technicianABA / autism services$20.8415 min$83.367
Behavioral health day treatmentBehavioral health$35.60hour$35.606
Behavioral health services (fee schedule)Behavioral health$28.36hour$57.3290
Comprehensive community support servicesBehavioral health$9.2815 min$37.1012
Crisis intervention (behavioral health)Behavioral health$37.04—$88.92123
Mental health assessment (non-physician)Behavioral health$38.10——1
Mental health counselingBehavioral health$32.01——6
Mental health service plan developmentBehavioral health$38.10——1
Opioid treatment: methadone administrationBehavioral health$31.92——24
Outpatient psychotherapy and diagnostic evaluationBehavioral health$95.71—$135.06275
Psychosocial rehabilitationBehavioral health$13.39—$53.56100
Screening, brief intervention and referral (SBIRT)Behavioral health$16.4115 min$65.6434
Skills training and developmentBehavioral health$9.5315 min$38.121
SUD residential treatment (per day)Behavioral health$165.69day—2
SUD residential treatment complexity add-on (per day)Behavioral health$30.90day—6
Therapeutic behavioral servicesBehavioral health$7.5615 min$30.244
Dental servicesDental$193.20——1387
Durable medical equipmentEquipment & supplies$66.01—$80.441609
Enteral and parenteral nutritionEquipment & supplies$2.48——68
Medical suppliesEquipment & supplies$27.66——834
Orthotics and prostheticsEquipment & supplies$282.00——1669
Adult day servicesOther home & community services$2.63day—1
Adult foster careOther home & community services$275.51day—8
Assisted living / alternative living servicesOther home & community services$133.38day—7
Bereavement services (child/family)Other home & community services$660.00Each—3
Case management / support coordinationOther home & community services$18.5815 min$47.9256
Community integration (older adults / disability waivers)Other home & community services$17.7215-min.—2
Extra child care for children with disabilitiesOther home & community services$8.11day—12
Family and peer mentoringOther home & community services$3.3315-min.—6
Financial management services (self-direction)Other home & community services$56.03month—4
HCBS waiver service (other)Other home & community services$55.7415-min.—22
Independent living skills trainingOther home & community services$9.81hour$19.8612
Interpreter servicesOther home & community services$9.4715 min$37.881
Nurse wellness counseling visitOther home & community services$5.9415-min.—6
Nursing assessmentOther home & community services$87.68——4
Prescribed pediatric extended care (medical day care)Other home & community services$39.23hour$39.232
Respite care (daily)Other home & community services$304.50day—26
Respite care (hourly)Other home & community services$7.1815-min.—36
Self-direction coaching / supports brokerOther home & community services$10.0015-min.—2
Service planning meetingOther home & community services$84.36——1
Supportive housing and housing transition supportsOther home & community services$14.06day—2
Home health aide visitHome health$44.01visit—2
Home health visit (other or unspecified)Home health$44.01visit—2
Hospice continuous home care (hourly)Hospice$66.83hour$66.8331
Hospice end-of-life visit add-on (per hour)Hospice$16.7115 min$66.8462
Hospice general inpatient care (daily)Hospice$1,156.96day—31
Hospice inpatient respite (daily)Hospice$541.26day—31
Hospice room and board in a nursing homeHospice$95.00——1
Hospice routine home care (daily)Hospice$196.51day—62
Inpatient DRG pricing input (outlier, cost ratio, stay)Hospital inpatient$0.95——612
Inpatient DRG relative weightHospital inpatient$1.69——1356
Inpatient hospital stay (DRG base rate)Hospital inpatient$8,049.89——153
Inpatient hospital stay (per diem)Hospital inpatient$1,694.03——21
Inpatient payment adjustment factorHospital inpatient$1.00——160
Inpatient psychiatric stay (per day)Hospital inpatient$1,550.12——18
Inpatient rate add-on (education, wage, directed payment)Hospital inpatient$4,114.00——3
EAPG relative weight (outpatient hospital or surgery center)Hospital outpatient$0.9152——608
IHS / tribal outpatient visit (all-inclusive rate)Hospital outpatient$826.00visit—1
Outpatient hospital add-on paymentHospital outpatient$937.00visit—3
Outpatient hospital conversion factor (APC/EAPG)Hospital outpatient$125.56——187
Outpatient hospital services (fee schedule)Hospital outpatient$138.90——47
Surgery center facility fee (per procedure)Hospital outpatient$212.39——9
Employment explorationIDD services$31.25hour$31.256
ICF/IID bed-hold (leave) dayIDD services$211.61——60
ICF/IID stay (daily rate)IDD services$671.43——174
ICF/IID supplemental daily paymentIDD services$92.50——14
Supported employment (job coaching)IDD services$420.0015 min$46.049
Clinical lab testsLab & pathology$16.04——4432
Nursing facility case-mix (PDPM nursing component) weightNursing facility$1.47——33
Nursing home bed-hold (leave) dayNursing facility$188.75——3271
Nursing home daily add-on (ventilator, trach, insurance)Nursing facility$35.00——1152
Nursing home daily rate component (facility-specific)Nursing facility$25.39——2256
Nursing home statewide price componentNursing facility$178.01——2
Nursing home stay (daily rate)Nursing facility$226.35—$95.004018
Nursing home ventilator care (daily rate)Nursing facility$993.12——1
Specialty nursing home daily rate (pediatric or IDD class)Nursing facility$1,053.65——1
Dialysis facility composite rate (per treatment)Other$214.60day—320
Directed payment uniform increase (required MCO uplift)Other$364.00percent—17
Directed payment: plan payment level (% of benchmark)Other$41.07percent—19
Managed care capitation rateOther$287.96month—14044
School-based Medicaid service (billed by a school district)Other$28.17—$72.8668
Personal care / attendant care (hourly)Personal care & attendant$7.18—$25.0428
Physician-administered drugs (J-codes)Pharmacy$8.12——1089
Private duty nursing (hourly shifts)Private duty nursing$46.38hour$46.384
Waiver nursing (RN or LPN, by the 15 minutes)Private duty nursing$25.0015 min$100.001
Physician and practitioner services (fee schedule)Physician & professional$246.12—$90.7235646
Imaging and radiologyRadiology$69.01——5559
Activity therapyTherapy (PT/OT/speech)$178.50Session—1
Cognitive rehabilitation therapyTherapy (PT/OT/speech)$18.8615 min$75.4462
Occupational therapyTherapy (PT/OT/speech)$20.0015 min$80.00102
Occupational therapy evaluationTherapy (PT/OT/speech)$62.66——72
Orthotic and prosthetic fitting and trainingTherapy (PT/OT/speech)$25.8515 min$103.4040
Other therapy servicesTherapy (PT/OT/speech)$14.42——124
Physical therapyTherapy (PT/OT/speech)$20.2915 min$81.1690
Physical therapy evaluationTherapy (PT/OT/speech)$64.23——84
Speech-generating device evaluationTherapy (PT/OT/speech)$96.62——15
Speech-generating device therapyTherapy (PT/OT/speech)$80.71——13
Speech-language evaluationTherapy (PT/OT/speech)$103.44——81
Speech-language therapyTherapy (PT/OT/speech)$69.86——34
Swallowing and feeding evaluationTherapy (PT/OT/speech)$75.84——13
Swallowing and feeding therapyTherapy (PT/OT/speech)$65.44——13
Air ambulance transportTransportation$3,219.82——5
Ambulance extras (waiting time, extra attendant, neonatal)Transportation$21.95——2
Ambulance mileageTransportation$9.14mile—7
Ground ambulance transportTransportation$41.07——35
Non-emergency medical transportation (NEMT)Transportation$8.48——21
Waiver transportation (to community activities)Transportation$28.141 trip—3
Eyeglasses and contact lensesVision & hearing$10.49——100
Hearing aids and hearing servicesVision & hearing$32.53——49
Hearing tests and audiology servicesVision & hearing$42.38——2

Most-compared billing codes in Wisconsin

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

CodeServiceWisconsinAll-state medianRank
10004Physician and practitioner services (fee schedule)$40.18$36.988 of 25
10005Physician and practitioner services (fee schedule)$98.26$65.158 of 25
10006Physician and practitioner services (fee schedule)$46.68$41.547 of 25
10007Physician and practitioner services (fee schedule)$222.19$82.816 of 25
10008Physician and practitioner services (fee schedule)$125.21$52.435 of 25
10009Physician and practitioner services (fee schedule)$364.35$100.275 of 25
10010Physician and practitioner services (fee schedule)$219.48$71.324 of 25
10021Physician and practitioner services (fee schedule)$67.99$53.008 of 25
10030Physician and practitioner services (fee schedule)$103.88$122.8717 of 25
10035Physician and practitioner services (fee schedule)$374.23$75.573 of 25
10036Physician and practitioner services (fee schedule)$325.03$38.243 of 25
10060Physician and practitioner services (fee schedule)$36.38$75.1723 of 25
10061Physician and practitioner services (fee schedule)$82.32$128.7222 of 25
10080Physician and practitioner services (fee schedule)$54.31$78.7320 of 25
10081Physician and practitioner services (fee schedule)$188.12$146.127 of 25
10120Physician and practitioner services (fee schedule)$46.45$79.4923 of 25
10121Physician and practitioner services (fee schedule)$121.78$137.6319 of 25
10140Physician and practitioner services (fee schedule)$44.46$89.0224 of 25
10160Physician and practitioner services (fee schedule)$30.17$69.5223 of 25
10180Physician and practitioner services (fee schedule)$110.98$151.2820 of 25
11000Physician and practitioner services (fee schedule)$29.11$26.2511 of 25
11001Physician and practitioner services (fee schedule)$42.66$13.801 of 25
11004Physician and practitioner services (fee schedule)$447.77$437.219 of 25
11005Physician and practitioner services (fee schedule)$609.10$574.708 of 25
11006Physician and practitioner services (fee schedule)$561.26$542.168 of 25
11008Physician and practitioner services (fee schedule)$227.84$208.646 of 25
11010Physician and practitioner services (fee schedule)$305.18$243.786 of 25
11011Physician and practitioner services (fee schedule)$359.33$268.005 of 25
11012Physician and practitioner services (fee schedule)$492.23$374.274 of 25
11042Physician and practitioner services (fee schedule)$56.10$56.1013 of 25
11043Physician and practitioner services (fee schedule)$205.77$143.404 of 25
11044Physician and practitioner services (fee schedule)$281.12$202.014 of 25
11055Physician and practitioner services (fee schedule)$23.22$16.759 of 25
11056Physician and practitioner services (fee schedule)$32.51$24.839 of 25
11057Physician and practitioner services (fee schedule)$41.79$31.278 of 25
11102Physician and practitioner services (fee schedule)$68.86$34.989 of 25
11103Physician and practitioner services (fee schedule)$37.14$20.258 of 25
11104Physician and practitioner services (fee schedule)$86.63$43.878 of 25
11105Physician and practitioner services (fee schedule)$42.53$23.938 of 25
11106Physician and practitioner services (fee schedule)$104.73$53.408 of 25

Managed care in Wisconsin

35 plans on record, 36 state-directed payment records, 43,640 published capitation cells.

Who sets the rate, line by line →

Recent rate changes and notices

Frequently asked questions

Where does Wisconsin publish its Medicaid fee schedules?

Wisconsin publishes rates across 98 official documents (fee schedules, rate notices and bulletins). Every rate on this page links to its source document.

How many Medicaid rates does Wisconsin publish?

83,088 rates are current across 117 services and 12 programs, with 123,396 versions on record since 1900-01-01.

Do Wisconsin Medicaid managed-care plans pay the fee schedule?

For 7 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.

Other states

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