Medicaid rates by service

322 services benchmarked across states, like-for-like by provider level and unit. Each page ranks every state and shows how the rate has changed.

ABA / autism services

Group ABA therapy led by a technician17 states · 302 rates One-on-one ABA therapy by a technician17 states · 240 rates ABA assessment by a behavior analyst17 states · 231 rates ABA therapy with plan changes by an analyst17 states · 207 rates ABA parent and caregiver training16 states · 183 rates Group ABA therapy led by an analyst14 states · 269 rates ABA assessment support by a technician12 states · 201 rates Group ABA parent training (several families)12 states · 161 rates ABA therapy with 2+ technicians (severe behavior)8 states · 57 rates ABA assessment with 2+ technicians (severe behavior)7 states · 57 rates Behavior analysis services (disability system)4 states · 3,921 rates

Behavioral health

Clinics (FQHC/RHC)

FQHC dental visit (PPS or APM rate)4 states · 3,762 rates FQHC/RHC behavioral health encounter rate1 states · 1,603 rates Multi-specialty interdisciplinary clinic visit (MSIC)1 states · 52 rates

Dental

Dental payment adjustment (percent of the fee schedule)2 states · 2 rates Dental supplemental payment (add-on to the fee schedule)1 states · 313 rates

Equipment & supplies

Enteral and parenteral nutrition19 states · 3,200 rates

Home health

Home health nurse visit (RN or LPN)19 states · 1,863 rates Home health aide visit18 states · 1,002 rates Home health physical therapy16 states · 722 rates Home health occupational therapy16 states · 717 rates Home health speech therapy15 states · 624 rates Home health visit (other or unspecified)6 states · 449 rates Home health agency daily rate / overhead3 states · 37 rates Home health therapy evaluation visit2 states · 274 rates RN management of the home care plan2 states · 11 rates Home health 60-day episode payment1 states · 654 rates Home health telemonitoring (daily monitoring or installation)1 states · 32 rates Home health per-visit pricing benchmark (LUPA/outlier)1 states · 18 rates

Hospice

Hospice routine home care (daily)18 states · 18,674 rates Hospice continuous home care (hourly)17 states · 19,772 rates Hospice end-of-life visit add-on (per hour)17 states · 9,873 rates Hospice general inpatient care (daily)17 states · 8,884 rates Hospice inpatient respite (daily)16 states · 8,750 rates Hospice room and board in a nursing home8 states · 12,674 rates Hospice residence care (daily)2 states · 326 rates Hospice room and board in an ICF/IID1 states · 628 rates Hospice nursing home bed-hold (leave) day1 states · 497 rates Hospice physician direct care (per service)1 states · 376 rates Hospice coinsurance amount (respite or drugs)1 states · 336 rates

Hospital inpatient

Inpatient hospital stay (per diem)13 states · 9,345 rates Inpatient psychiatric stay (per day)11 states · 9,350 rates Inpatient rate add-on (education, wage, directed payment)9 states · 15,135 rates Inpatient capital payment (building and equipment)5 states · 9,443 rates Hospital administrative (non-acute) day3 states · 7,989 rates Inpatient addiction treatment or detox (per day)3 states · 2,093 rates IHS / tribal hospital stay (all-inclusive daily rate)3 states · 37 rates Hospital day awaiting discharge (alternate level of care)2 states · 4,140 rates Organ or stem-cell transplant case rate (per component)1 states · 9,662 rates Hospital indigent care surcharge (HCRA)1 states · 3,936 rates Electroconvulsive therapy during a psychiatric stay1 states · 1,045 rates Inpatient bed-hold (leave) day1 states · 36 rates

Hospital outpatient

Outpatient payment adjustment factor7 states · 8,154 rates EAPG relative weight (outpatient hospital or surgery center)6 states · 22,314 rates Outpatient hospital conversion factor (APC/EAPG)6 states · 21,778 rates Surgery center payment group rate5 states · 888 rates IHS / tribal outpatient visit (all-inclusive rate)5 states · 119 rates Outpatient hospital (percent of charges or cost)3 states · 2,002 rates Outpatient hospital payment method2 states · 7,529 rates Outpatient hospital add-on payment2 states · 5,357 rates Legacy APG blend rate (zero since 2012)1 states · 28,040 rates Outpatient facility rate (other rate code)1 states · 24,842 rates APG relative weight1 states · 23,056 rates Emergency department APG base rate1 states · 6,585 rates Ambulatory surgery APG base rate1 states · 2,488 rates School-based health center APG base rate1 states · 1,619 rates

IDD services

Supported employment (job coaching)17 states · 5,973 rates Prevocational services15 states · 7,911 rates In-home and community living supports (IDD)15 states · 6,553 rates Community integration / community access (IDD)13 states · 2,506 rates Behavior support services (disability waiver)12 states · 365 rates Shared living / host home / family model10 states · 1,909 rates Employment exploration10 states · 484 rates ICF/IID stay (daily rate)7 states · 16,595 rates Supported employment follow-along7 states · 225 rates Intensive behavioral residential supports6 states · 2,040 rates Additional residential staffing6 states · 746 rates Benefits counseling6 states · 132 rates Transitional / crisis stabilization living supports6 states · 66 rates Consultative clinical assessment (IDD)5 states · 144 rates Rate-model staff wage (component, not a billable fee)3 states · 1,347 rates Remote supports (technology-based supervision)3 states · 180 rates Job development and self-employment outcome payments3 states · 165 rates ICF/IID bed-hold (leave) day2 states · 1,999 rates Communication specialist (IDD)2 states · 27 rates Developmental disability clinic visit (APG base rate)1 states · 6,483 rates IDD residential rate component (tier table)1 states · 2,406 rates ICF/IID day service (developmental training) provider rate1 states · 1,017 rates Tutoring (IDD)1 states · 744 rates Supplemental program support staffing (IDD, non-residential)1 states · 483 rates Residential habilitation room and board fee1 states · 214 rates High-needs / specialized population funding (I/DD)1 states · 112 rates Intervener for a person who is deaf-blind1 states · 34 rates MC/DD exceptional care per diem (feeding tube / tracheostomy)1 states · 15 rates Day treatment for people with I/DD (clinic)1 states · 14 rates Family medical support assistance1 states · 4 rates Home enabling supports (smart-home tech and setup)1 states · 4 rates Residential provider performance add-on (percent)1 states · 2 rates

Nursing facility

Nursing home bed-hold (leave) day5 states · 18,907 rates Swing-bed stay (hospital bed used for nursing-home care)5 states · 166 rates Specialty nursing home daily rate (pediatric or IDD class)4 states · 10,407 rates Nursing facility case-mix (PDPM nursing component) weight2 states · 28,826 rates Adult subacute nursing care (daily rate)2 states · 1,797 rates Nursing home ventilator care (daily rate)2 states · 10 rates Pediatric subacute care (daily rate)1 states · 36 rates Nursing home statewide price component1 states · 12 rates Nurse aide training and competency testing (NF)1 states · 9 rates Temporary nursing agency maximum rate (charged to nursing facilities)1 states · 6 rates Bed-hold / leave day reduction amount1 states · 4 rates

Other

Dialysis facility composite rate (per treatment)7 states · 4,379 rates Doula visit (prenatal or postpartum)6 states · 20 rates Doula support during labor and delivery5 states · 13 rates Early intervention services for infants and toddlers4 states · 19,610 rates Diabetes prevention program session or milestone payment4 states · 91 rates Childbirth, lactation or parenting class3 states · 43 rates Home infusion or injectable therapy (per diem, services and supplies)2 states · 138 rates Medical respite (recuperative care) for people experiencing homelessness, daily2 states · 7 rates Lactation consultation2 states · 6 rates Foster care agency health services (daily rate)1 states · 643 rates State-purchased human service (Chapter 257 rate)1 states · 331 rates Rest home (resident care facility) daily rate1 states · 218 rates Foster care agency health service (per service)1 states · 74 rates Brain/spinal cord injury rehab (state program, not Medicaid)1 states · 68 rates Prenatal care coordination for at-risk pregnancy (assessment, care coordination, enhanced package)1 states · 54 rates Maternal and infant health program visit (assessment, professional or home visit)1 states · 25 rates Birth center transfer fee1 states · 12 rates Birth center observation services rate1 states · 12 rates Personal needs allowance (amount a member keeps each month)1 states · 4 rates Traditional healing services1 states · 2 rates Pediatric outpatient intensive feeding program (per day)1 states · 1 rates School-based Medicaid service (billed by a school district)1 states · 1 rates

Other home & community services

Case management / support coordination20 states · 2,602 rates Respite care (hourly)19 states · 8,104 rates Adult day services17 states · 1,242 rates Respite care (daily)14 states · 3,002 rates Self-direction coaching / supports broker14 states · 548 rates Home-delivered meals14 states · 272 rates Assisted living / alternative living services13 states · 19,177 rates Emergency response system monitoring13 states · 182 rates Nursing assessment12 states · 334 rates Respite in a facility (daily)11 states · 464 rates Community transition (moving out of an institution)11 states · 218 rates Emergency response system installation11 states · 117 rates Financial management services (self-direction)10 states · 506 rates Interpreter services10 states · 248 rates Service planning meeting9 states · 119 rates Home modifications (accessibility)9 states · 39 rates Nursing respite (RN or LPN)8 states · 432 rates Family and peer mentoring7 states · 116 rates Adult day health (medical model)6 states · 3,012 rates Adult foster care6 states · 1,669 rates Community integration (older adults / disability waivers)6 states · 192 rates Other waiver goods and services6 states · 150 rates Family caregiver training and support6 states · 91 rates Prescribed pediatric extended care (medical day care)6 states · 79 rates Specialized medical equipment and supplies6 states · 68 rates Chore services (heavy cleaning, yard work, pest control)6 states · 29 rates Transitional care coordination (children's waiver)5 states · 161 rates Independent living skills training4 states · 2,507 rates Nurse wellness counseling visit4 states · 71 rates HCBS waiver service (other)4 states · 57 rates Children's waiver palliative care3 states · 137 rates HCBS provider incentive payment3 states · 29 rates Health Home care management (per month)2 states · 172 rates Bereavement services (child/family)2 states · 90 rates Assistive technology support (training and set-up)2 states · 47 rates Positive behavioral interventions and support2 states · 30 rates Supportive housing and housing transition supports2 states · 25 rates Assistive technology assessment2 states · 20 rates Brain injury rehabilitation services (Medicaid program)2 states · 10 rates Independent living assistance2 states · 5 rates Vehicle modifications2 states · 4 rates HCBS rate-model component (formula input, not a billable fee)1 states · 7,959 rates Requisition fee for adaptive aids or home modifications1 states · 329 rates Community residential services for people with a brain injury1 states · 156 rates Social work services (waiver)1 states · 136 rates Money management support1 states · 128 rates Caregiver support program benefit level (monthly cap)1 states · 114 rates Caregiver/family advocacy and support (child)1 states · 102 rates Medical foster care (medically complex child)1 states · 24 rates Residential room and board amount (state-set, paid by the member)1 states · 23 rates HCBS average payment rate (42 CFR 447.203 disclosure)1 states · 16 rates Home visit by medical personnel1 states · 14 rates Automated medication dispenser installation1 states · 7 rates Automated medication dispenser monthly service1 states · 7 rates Health care assessment (monthly, disability waiver)1 states · 3 rates Residential care bed-hold day1 states · 1 rates Extra child care for children with disabilities1 states · 1 rates

Personal care & attendant

Personal care / attendant care (hourly)20 states · 13,716 rates Homemaker / housekeeping help14 states · 1,701 rates Home health aide or nurse aide care (hourly)9 states · 183 rates Companion care8 states · 333 rates Personal care (daily rate)7 states · 1,101 rates Home care worker wage scale (collective bargaining)3 states · 421 rates Personal assistance retainer payment3 states · 32 rates Structured family caregiving (daily)3 states · 30 rates Training for unpaid family caregivers3 states · 25 rates Live-in personal care (24-hour)1 states · 306 rates Nurse supervision visit for personal care1 states · 240 rates Flexible family support (attendant or nurse)1 states · 87 rates Coordinated caregiving (live-in caregiver support)1 states · 27 rates

Pharmacy

Vaccines and immune globulins8 states · 3,667 rates Pharmacy dispensing fee7 states · 68 rates Pharmacist medication therapy management (case rate)3 states · 24 rates Drug ingredient cost (pricing basis)1 states · 2 rates

Physician & professional

Anesthesia conversion factor12 states · 25,733 rates Anesthesia base units (per procedure)10 states · 23,352 rates Physician fee schedule conversion factor4 states · 1,453 rates Community health worker education and training4 states · 65 rates Payment percentage for non-physician practitioners4 states · 34 rates Practitioner payment adjustment (percent or set amount)3 states · 78 rates Telehealth originating-site facility fee2 states · 35 rates Wellness coaching by a certified coach2 states · 24 rates Online digital visit (e-visit) by a non-physician1 states · 9 rates

Private duty nursing

Private duty nursing (hourly shifts)18 states · 1,645 rates Waiver nursing (RN or LPN, by the 15 minutes)16 states · 1,570 rates Nurse shadowing / home care training6 states · 30 rates Private duty nursing enhancement (percent add-on)1 states · 2 rates

Therapy (PT/OT/speech)

Speech-language therapy20 states · 4,430 rates Physical therapy20 states · 3,364 rates Occupational therapy20 states · 3,240 rates Occupational therapy evaluation19 states · 1,871 rates Physical therapy evaluation19 states · 1,858 rates Nutrition counseling (dietitian)19 states · 975 rates Swallowing and feeding evaluation19 states · 696 rates Speech-language evaluation18 states · 1,872 rates Swallowing and feeding therapy17 states · 546 rates Speech-generating device therapy16 states · 303 rates Speech-generating device evaluation15 states · 299 rates Cognitive rehabilitation therapy14 states · 485 rates Orthotic and prosthetic fitting and training13 states · 997 rates Other therapy services9 states · 14,283 rates Activity therapy6 states · 157 rates Respiratory therapy at home4 states · 169 rates Orientation and mobility training (vision loss)3 states · 35 rates Audiology and auditory integration training2 states · 774 rates Respiratory therapy evaluation2 states · 80 rates

Transportation

Ground ambulance transport20 states · 8,069 rates Ambulance mileage18 states · 2,771 rates Non-emergency medical transportation (NEMT)17 states · 3,136 rates Air ambulance transport17 states · 2,983 rates Waiver transportation (to community activities)14 states · 4,403 rates Ambulance extras (waiting time, extra attendant, neonatal)8 states · 1,579 rates Staff mileage add-on5 states · 21,209 rates Travel lodging for a medical appointment (per night)3 states · 43 rates Escort / attendant on waiver transportation2 states · 186 rates

Vision & hearing

Eyeglasses and contact lenses19 states · 14,763 rates Hearing aids and hearing services19 states · 2,264 rates Eye exams and vision services5 states · 3,185 rates Hearing tests and audiology services3 states · 2,268 rates

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