A Medicaid fee schedule is the list of payment amounts a state Medicaid program sets for covered healthcare services, usually tied to CPT or HCPCS codes. Rates shift based on the state, the service, the provider type, the payment method, and the effective date.
Here’s the thing people miss most often: there is no single national Medicaid fee schedule. Each state runs its own Medicaid program inside federal guardrails, with real flexibility over how it pays providers.
For a consumer, that means a published Medicaid rate is really a provider-payment reference. It won’t necessarily match what your doctor, hospital, dentist, or therapist actually collects on a given claim.
Medicaid Fee Schedule by State: 50-State Lookup
Start by pinning down which state is responsible for your Medicaid coverage. CMS publishes state Medicaid and CHIP profiles along with state contact information.
| State | Medicaid Program/Resource |
|---|---|
| Alabama Medicaid Fee Schedule | Alabama Medicaid |
| Alaska Medicaid Fee Schedule | Alaska Medicaid |
| Arizona AHCCCS Fee Schedule | AHCCCS |
| Arkansas Medicaid Fee Schedule | Arkansas Medicaid |
| California Medi-Cal Fee Schedule | Medi-Cal |
| Health First Colorado Fee Schedule | Health First Colorado |
| Connecticut Medicaid Fee Schedule | Connecticut Medicaid |
| Delaware Medicaid Fee Schedule | Delaware Medicaid & Medical Assistance |
| Florida Medicaid Fee Schedule | Florida Medicaid |
| Georgia | Georgia Medicaid |
| Hawaii | Hawaii Medicaid |
| Idaho Medicaid Fee Schedule | Idaho Medicaid |
| Illinois Medicaid Fee Schedule | Illinois Medicaid |
| Indiana | Indiana Medicaid |
| Iowa | Iowa Medicaid |
| Kansas | KanCare |
| Kentucky | Kentucky Medicaid |
| Louisiana | Louisiana Medicaid |
| Maine Mainecare Fee Schedule | MaineCare |
| Maryland | Maryland Medicaid |
| Massachusetts MassHealth Fee Schedule | MassHealth |
| Michigan | Michigan Medicaid |
| Minnesota | Minnesota Medicaid |
| Mississippi | Mississippi Medicaid |
| Missouri | Missouri Medicaid |
| Montana | Montana Medicaid |
| Nebraska | Nebraska Medicaid |
| Nevada | Nevada Medicaid |
| New Hampshire | New Hampshire Medicaid |
| New Jersey | New Jersey Medicaid |
| New Mexico | New Mexico Medicaid |
| New York Medicaid Fee Schedule | New York Medicaid |
| North Carolina | NC Medicaid |
| North Dakota | North Dakota Medicaid |
| Ohio | Ohio Medicaid |
| Oklahoma | Oklahoma Medicaid |
| Oregon | Oregon Medicaid |
| Pennsylvania | Pennsylvania Medical Assistance |
| Rhode Island | Rhode Island Medicaid |
| South Carolina | South Carolina Medicaid |
| South Dakota | South Dakota Medicaid |
| Tennessee | TennCare |
| Texas Medicaid Fee Schedule | Texas Medicaid |
| Utah | Utah Medicaid |
| Vermont | Vermont Medicaid |
| Virginia | Virginia Medicaid |
| Washington | Washington Apple Health Fee Schedule |
| West Virginia | West Virginia Medicaid |
| Wisconsin | Wisconsin Medicaid |
| Wyoming | Wyoming Medicaid |
CMS keeps a state-by-state contact directory. Your state Medicaid agency is also the right place to ask about eligibility, claims, providers, and program-specific questions — not a third-party site.
Also See 2026 Medicaid Income Limits by State →
Important: A State Name Is Not Enough
Typing “Texas Medicaid fee schedule” or “California Medicaid reimbursement rates” into a search bar gets you nowhere close to a real answer. You still need to nail down:
- Provider type
- Service category
- CPT or HCPCS code
- Modifier
- Place of service
- Effective date
- Fee-for-service or managed care
- Coverage requirements
- Prior authorization requirements
How to Find Your Exact Medicaid Rate
Work through these steps in order:
- Select your state.
- Open the official state Medicaid agency website.
- Choose the appropriate provider or service category.
- Search for the CPT or HCPCS procedure code.
- Check the effective date of the published rate.
- Determine whether the rate applies to FFS or managed care.
- Check coverage, modifiers, units, and authorization requirements.
Skip a step and you risk pulling a rate that has nothing to do with your actual situation. The same procedure code can carry wildly different payment amounts depending on circumstances that seem minor but aren’t.
Check If Your State’s 2027 Medicaid Rules Have Changed
CPT, HCPCS and Medicaid Rates
CPT codes cover most medical procedures and professional services. HCPCS is the wider system — it absorbs CPT codes and adds codes for products, supplies, transportation, and other services CPT doesn’t touch.
Don’t search by service name alone. Use the exact billing code whenever you have it.
Say you’re trying to find the Medicaid reimbursement for an office visit. Verify the CPT code, the modifier, the provider type, and the effective date. A generic “doctor visit” search won’t get you a real number.
Why Modifiers Matter
A modifier tells the payer something extra about how or where a service happened. Depending on the state, that small addition can change what gets paid.
CPT code + modifier + provider type + applicable Medicaid rules — together, that combination beats the plain procedure description every time.
How Medicaid Rates Are Determined
States get wide latitude in setting Medicaid fee-for-service payment rates. For physician services, the common approaches include:
- RBRVS — Resource-Based Relative Value Scale
- A percentage of Medicare payment amounts
- State-developed fee schedules
- Geographic or market factors
- Provider-specific adjustments
- Supplemental or incentive payments
MACPAC lays this out plainly: states may lean on RBRVS, Medicare-based methods, or something built entirely in-house when setting physician payment rates.
State Plans and State Plan Amendments (SPAs) shape reimbursement policy too. CMS runs a searchable database of approved amendments, reimbursement changes included.
Medicaid Fee-for-Service vs. Managed Care
One of the biggest points of confusion? Assuming every Medicaid member gets paid under the same fee schedule. They don’t. There are two major payment arrangements.
| Feature | Fee-for-Service (FFS) | Managed Care |
|---|---|---|
| Who pays provider? | Generally the state Medicaid program | Medicaid managed-care organization |
| Payment basis | Individual covered services | Contract/capitation-based system |
| State fee schedule relevance | Usually direct | May be a benchmark or affected by contracts |
| Provider network | Program rules | MCO network rules |
| Consumer consideration | Covered service and billing rules | Plan/network and contract rules |
Under FFS, the state pays providers directly for each covered service. Under managed care, the state pays a managed-care organization, and that MCO pays providers under its own contracts.
So a state Medicaid fee schedule doesn’t automatically reflect what a managed-care provider actually receives. Worth remembering.
Medicaid vs. Medicare Fee Schedules
Medicaid and Medicare aren’t run the same way. Medicare is federally administered. Medicaid is jointly funded and run by states, inside federal requirements.
Medicaid rates can land lower than Medicare, similar to it, or occasionally higher — it depends entirely on the service and circumstances. Any real comparison has to match the same service, code, provider type, state, and time period, or it’s meaningless.
MACPAC reports significant variation across states and services. KFF’s state-level Medicaid-to-Medicare fee-index data backs that up — the relationship swings a lot depending on state and service category.
Be skeptical of anyone claiming “Medicaid always pays X% of Medicare.” That’s not how it works.
2026 Medicaid Fee Schedule Transparency
2026 matters a lot for anyone researching Medicaid fee schedules.
CMS guidance implementing the Medicaid access rule requires states to initially publish Medicaid fee-for-service payment rates no later than July 1, 2026 — including approved FFS rates in effect as of that date.
That’s a genuine step toward making FFS payment information publicly accessible. But don’t read too much into it. This isn’t one national Medicaid price list suddenly appearing. States still run different payment methodologies, cover different services and codes, use different provider categories, and set their own effective dates.
KFF’s 2025–2026 Medicaid budget survey found states are still actively changing provider payment rates — a reflection of each state’s own fiscal and policy pressures.
Does the Published Medicaid Rate Guarantee Payment?
No. Treat a fee-schedule amount as a reference point, not a promise. Actual payment can hinge on:
- Whether the service is covered
- Correct CPT/HCPCS coding
- Modifiers
- Provider enrollment
- Provider type
- Units billed
- Place of service
- Prior authorization
- Claim-processing rules
- Effective date
- FFS versus managed care
- Supplemental or directed payment arrangements
A published rate is a starting point. Not a guarantee.
Why Medicaid Rates Differ by State
Medicaid runs as a federal-state partnership, but states hold significant authority over program design and payment policy. That authority is exactly why rates diverge so much. States differ on:
- Payment methodologies
- Budgets
- Provider reimbursement policies
- Service definitions
- Geographic considerations
- Provider incentives
- State Plan provisions
- Managed-care arrangements
KFF’s research shows states continuing to make different rate decisions as they respond to their own fiscal conditions and policy priorities.
What This Means for Medicaid Members
If you’re a Medicaid beneficiary, you almost never need to calculate a provider’s reimbursement rate yourself. Honestly, that’s not your job. What you actually need to know is more practical:
- Does my Medicaid program cover this service?
- Is my doctor enrolled with Medicaid?
- Is my doctor in my managed-care network?
- Do I need prior authorization?
- What will I owe?
- Which providers accept my specific Medicaid plan?
CMS points consumers to their state Medicaid agency for claims questions and for finding Medicaid healthcare providers.
Searching “Medicaid doctor near me,” “Medicaid dentist near me,” or “Medicaid provider near me”? Use your state’s provider directory or your managed-care plan’s network directory. A fee schedule alone won’t answer that question.
Common Mistakes When Checking Medicaid Rates
1. Using an old schedule
Always verify the effective date. Rates change, and an outdated number is worse than no number.
2. Using the wrong provider category
Physician, dental, behavioral health, DME, ambulance, home health, HCBS, and nursing-facility schedules each follow their own rules.
3. Confusing FFS with managed care
A published FFS rate may have little to do with what your MCO actually pays its network providers.
4. Ignoring modifiers
The base CPT or HCPCS rate rarely tells the whole story on its own.
5. Comparing unrelated services
A real Medicaid-versus-Medicare comparison requires matching the code, service, provider category, state, and period — every time.
6. Assuming a fee means coverage
A listed payment rate doesn’t guarantee every Medicaid member is covered for that service.
A Simple Decision Path
Want to find a Medicaid rate? Walk through this:
- Know your state? → Open the official state Medicaid agency.
- Know the service? → Identify the CPT/HCPCS code.
- Know the provider type? → Select the appropriate fee schedule.
- Have the code? → Check the rate and effective date.
- Have managed care? → Verify your MCO’s provider-payment/network rules.
- Still uncertain? → Contact the state Medicaid agency or your health plan.
Frequently Asked Questions
Does every state have a Medicaid fee schedule?
States have Medicaid payment policies and, where applicable, FFS fee schedules — but the format and availability differ by state. CMS’s 2026 transparency requirements are pushing more of this information into public view.
Does Medicaid have one national reimbursement rate?
No. Rates vary by state, service, provider type, methodology, coding, and effective date.
How much does Medicaid pay for a doctor visit?
There’s no single national figure. It depends on the state, the specific CPT code, the provider type, the Medicaid delivery system, and the rules that apply.
Does Medicaid pay the same as Medicare?
Not necessarily. The two programs use different payment systems, and how they compare shifts by state and service.
How often do Medicaid rates change?
No universal schedule governs every rate. States update at different times, driven by budgets, State Plan Amendments, legislation, or policy decisions.
Can managed-care Medicaid use different provider payment rates?
Yes. MCOs operate under contracts with states, and their provider-payment arrangements can differ from the state’s direct FFS structure.
Does a published fee schedule guarantee that a provider will be paid that amount?
No. Coverage, coding, modifiers, authorization, provider status, delivery system, and claim rules can all shift the final payment.
Where can I find my state’s Medicaid information?
CMS provides state profiles and Medicaid agency contact information. Start there.
Why won’t my doctor accept Medicaid?
The provider may not participate in Medicaid, may not be accepting new Medicaid patients, or may sit outside your managed-care network. Payment and administrative factors often play into that decision too.
Conclusion
There’s no such thing as one nationwide Medicaid price list. What you actually pay — or what your provider actually collects — depends on the state, the service, the CPT/HCPCS code, the provider type, the effective date, the payment methodology, and whether you’re in FFS or managed care.
Start with your official state Medicaid agency. Get the exact procedure code and provider category. Check the effective date. Confirm whether the rate you’re looking at even applies to your delivery system. Skip any of that, and the number you find is just a number — not an answer.
The fee schedule is a useful tool for understanding how Medicaid payment works. But coverage, providers, networks, claims, and what you personally owe — verify those with your state Medicaid agency or health plan directly.
Official Resources
- Find Your State’s Medicaid Rates — Medicaid.gov State Overviews
- Check CPT/HCPCS Payment Amounts — CMS Physician Fee Schedule Look-Up Tool
- Verify Medicaid Program Rules by State — Medicaid.gov
- See National Fee Schedule Data — CMS.gov
Disclaimer: Medicaid rules and payment rates change by state and over time. This guide is for general informational purposes only and is not legal, medical, billing, or financial advice. Always confirm latest rates, coverage, and payment policy with the official state Medicaid agency or your Medicaid health plan.