See the current North Dakota Medicaid fee schedule. It’s like a big price list that tells doctors and helpers how much Medicaid pays for covered medical services, procedures, equipment, and other eligible care. North Dakota Health and Human Services (HHS) puts these schedules and rate details on its official provider website.
The state added a 2% provider inflationary increase effective July 1, 2026. It also changed how reimbursement is figured out for certain procedure codes. But hold on! The money a provider really gets still depends on the service, procedure code, provider type, modifiers, coverage requirements, and date of service. It’s like a puzzle with lots of pieces. The official North Dakota Medicaid rate update explains all the details.
Where should you start? Go to the official North Dakota Medicaid Rates and Fee Schedules page. It has the general, dental, behavioral health, ambulance, durable medical equipment (DME), and other special schedules. Want to see how North Dakota stacks up against other states? Our Medicaid fee schedule by state guide puts the numbers side by side.
What Is the North Dakota Medicaid Fee Schedule?
It’s the official helper book for allowable Medicaid reimbursement. Procedure codes, service descriptions, coverage information, and payment rates all live inside it.
For most services, North Dakota Medicaid pays the lesser of the provider’s billed charge or the established maximum allowable fee. That means it pays the smaller number! A listed rate doesn’t promise payment, and it doesn’t prove something is covered either. Medicaid policies, authorization requirements, and billing rules still count, just like North Dakota HHS says.
Eligibility is a different thing from reimbursement. Whether a member can get coverage at all based on Medicaid income limits, which is a totally different question from what a provider gets paid.
Quick answer: To find a North Dakota Medicaid rate, open the official HHS fee schedule website or procedure code lookup tool, pick the service or type in the CPT/HCPCS code, and check the rate, coverage status, modifiers, and authorization requirements.
How to Find the North Dakota Medicaid Fee Schedule for 2026
Just follow six steps and you’ll find the right number!
- Visit the official fee schedule page. Open the North Dakota Medicaid Rates and Fee Schedules website.
- Choose the relevant service category. Pick professional services, dental, DME, behavioral health, or another special rate file, depending on what you bill.
- Identify the procedure code. Find the right Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), or other code that fits.
- Check the current allowed amount. Make sure the rate and its effective date are right. An old downloaded file is a sneaky trap!
- Review billing requirements. Coverage notes, modifiers, prior authorization, telehealth eligibility, and other rules all matter here.
- Confirm the applicable date of service. Sending in an older claim? Today’s rate might not be the right one for that date.
North Dakota HHS freshens up the fee schedule files every week, usually on Sunday. The department also warns that rates can change in the middle of the year before the online page catches up, so keep an eye on provider communications too. The official fee schedule guidance has all the specifics.
North Dakota Medicaid Fee Schedule Categories
Reimbursement rules are different for each kind of service and provider, so North Dakota publishes lots of separate schedules.
| Fee schedule | Services covered |
|---|---|
| General Services | Professional medical and surgical services, diagnostic services, vaccines, and vision |
| Dental Services | Adult dental, child dental, and orthodontic services |
| Durable Medical Equipment (DME) | Eligible equipment and supplies, including purchase and rental rates |
| Behavioral Health | Certain behavioral health rehabilitation, substance use disorder treatment, and related services |
| Ambulance Services | Covered ambulance services |
| Home and Community-Based Services (HCBS) | Applicable approved home and community-based services |
| Non-Emergency Medical Transportation (NEMT) | Eligible non-emergency medical transportation |
| Home Health | Applicable home health rates |
| Facility Rates | Certain hospital, nursing facility, and other institutional services |
Every file on the official website has its own effective date. Right now the page lists general services and DME schedules effective August 1, 2026, and several special schedules effective July 1, 2026. Don’t think every rate changed on the same day.
North Dakota Medicaid Reimbursement Rate Changes for 2026
The July 2026 update is the super big one for providers.
North Dakota HHS announced a 2% provider inflationary increase for services effective July 1, 2026, following the legislative mandate for the second year of the biennium. Relative Value Unit (RVU) changes came along with it for services priced that way, as the North Dakota Medicaid provider updates explain.
The department shared these conversion factors for dates of service on or after July 1, 2026:
- Professional services conversion factor: $37.5492.
- Ambulatory surgical center (ASC) conversion factor: $32.41.
- Anesthesia conversion factor: $27.06.
Remember, these are calculation factors. They are not flat payments for a visit or procedure!
For RVU-priced services, the final amount changes depending on procedure-specific RVUs and other pricing adjustments. HHS said that, all together, providers paid under the RVU methodology would see a 2% increase. But single procedure rates might go up, stay the same, or go down.
So always check the code-level rate. If you just add 2% to last year’s fee, you’ll get the wrong answer.
There are also policy changes besides rates that are worth a peek. Providers serving expansion populations should read about the new Medicaid work requirements by state, because enrollment changes can change how much billing happens.
How to Use the North Dakota Medicaid Procedure Code Lookup Tool
The official procedure code lookup tool is like a magic search box. It shows code-specific requirements and reimbursement details all in one place!
Visit the North Dakota Medicaid Procedure Code Lookup Tool, search the code, and look at three sections.
1. Summary
You’ll see the service category, whether North Dakota Medicaid covers the code, and whether telehealth is allowed.
2. Rates
What shows up depends on the code. You might see a professional rate, technical rate, general rate, anesthesia base, DME rental rate, ASC rate, or adult and child dental rates.
3. Requirements
This part tells you if a National Drug Code (NDC), the ordering/referring/prescribing provider’s National Provider Identifier (NPI), or other information is needed. It also shows whether a service counts toward an encounter payment for a federally qualified health center (FQHC), rural health clinic (RHC), or Indian Health Service or Tribal health program.
The tool only shows the current rate. For old reimbursement, go to the fee schedule archive. And even if a code shows up in the tool, you still have to check coverage rules and service authorization. The official lookup guidance has more.
Does a Listed North Dakota Medicaid Rate Guarantee Payment?
Nope! A listed fee is not a promise that North Dakota Medicaid will pay that amount on your claim.
Payment depends on lots of things:
- Whether the service is covered for the member on the date of service.
- Whether you’re enrolled and allowed to bill.
- Whether the billed code and modifiers are correct.
- Whether prior authorization or other service requirements apply.
- Whether a different reimbursement methodology sets the allowable amount.
- Whether the billed charge is lower than the maximum allowable fee.
Remember the starting rule: for most services, Medicaid pays the lesser of the billed charge or the maximum allowable fee. Some codes have no set published price. Those can be manually priced, paid from an invoice, or reimbursed at zero, depending on the rules.
One more thing from the state! Bill your usual and customary charges for Medicaid members. The Medicaid fee schedule isn’t made to set your public prices, according to the North Dakota HHS fee schedule instructions.
Where Can Providers Find Historical North Dakota Medicaid Rates?
The archive on the official fee schedule page is the spot! Looking into a past claim, comparing reimbursement changes, or checking an older service date? Start there.
HHS lists archived files for earlier 2026 updates, including February, April, and July schedules for different service categories, plus older schedules for some services.
Compare things that match, like apples to apples! Use the same service category, same procedure code, same effective dates, modifiers, provider type, and methodology. Don’t just use an archived rate on a current claim automatically.
Provider manuals and guidelines help with billing and policy questions beyond the rate files.
North Dakota Medicaid Provider Contact Information
Can’t find a code? Not sure about a rate or a billing rule? Reach out to North Dakota HHS through its official provider resources.
Medical Services Division
North Dakota Health and Human Services
600 E. Boulevard Ave., Department 325
Bismarck, ND 58505-0250
- Medical Services Division: (701) 328-7068
- Toll-free: (800) 755-2604
- General claims, payment, denial, and eligibility questions: (701) 328-7098 or (877) 328-7098
- Email: dhsmed@nd.gov
Check the official provider guidance page to make sure the contact details and the right department are correct before you call.
Frequently Asked Questions
1. Where can I find the North Dakota Medicaid fee schedule for 2026?
On the official North Dakota Medicaid Rates and Fee Schedules page. Current schedules, special provider rates, and archived files are all hanging out there.
2. Did North Dakota Medicaid increase provider rates in 2026?
Yes! HHS announced a 2% provider inflationary increase effective July 1, 2026. Because of RVU adjustments, single procedure rates can go up, stay the same, or go down.
3. How do I look up a North Dakota Medicaid CPT code?
Open the official procedure code lookup tool and search the code. You’ll see the rate, coverage status, modifiers, and other requirements.
4. Are all North Dakota Medicaid fee schedules updated on the same date?
No way! Each service category has its own effective date, so check the date on the exact schedule you need and read provider updates for later changes.
5. Does the North Dakota Medicaid fee schedule guarantee reimbursement?
No. Coverage, eligibility, billing requirements, authorization rules, modifiers, and the reimbursement methodology all decide what gets paid. A published fee by itself guarantees nothing.
6. What is the North Dakota Medicaid professional services conversion factor for July 2026?
$37.5492 for dates of service on or after July 1, 2026. It’s a pricing factor inside the reimbursement methodology, not a payment amount for everyone.
7. Where can I find North Dakota Medicaid dental and DME rates?
Pick the dental or durable medical equipment category on the official fee schedule page. Dental schedules cover adult and child services, and DME schedules keep equipment purchase and rental rates apart.
8. How can I check previous North Dakota Medicaid reimbursement rates?
Use the archived files on the official fee schedule page. Pick the schedule that matches your service category and date of service.
9. What should I do if a procedure code is missing from the fee schedule?
Run it through the procedure code lookup tool, then check provider policy and current HHS guidance. A missing code doesn’t mean the service isn’t covered. Some codes are manually priced or handled under another reimbursement method.
Conclusion
The July 1, 2026 update brought a 2% inflationary increase and new RVU-based pricing, but the number that really counts is the one connected to your code and your date of service. Look that up before you bill, every single time!
When a rate looks wrong, don’t just guess. Call North Dakota Medicaid and get it in writing.
Disclaimer: This article is for general educational purposes only and is not legal, medical, billing, or reimbursement advice. Fee schedules and Medicaid policies can change. Always verify current rates and requirements with North Dakota Health and Human Services before relying on them.