Other Medicaid rates by code
19 other codes with published Medicaid rates in five or more states. Each page compares every state's rate, unit and managed-care rule.
- Codes
- 19
- In 40+ states
- 0
All other codes
| Code | Service | States | Median rate |
|---|---|---|---|
| 0841 | Dialysis facility composite rate (per treatment) | 5 | $81.95 |
| 0851 | Dialysis facility composite rate (per treatment) | 5 | $81.95 |
| 90999 | Dialysis facility composite rate (per treatment) | 13 | $145.13 |
| G9873 | First medicare diabetes prevention program | 5 | $22.46 |
| G9874 | Four total medicare diabetes prevention program | 5 | $44.93 |
| G9875 | Nine total medicare diabetes prevention program | 5 | $81.22 |
| G9876 | Two medicare diabetes prevention program | 5 | $18.53 |
| G9877 | Two medicare diabetes prevention program | 5 | $18.53 |
| G9878 | Two medicare diabetes prevention program | 5 | $50.00 |
| G9879 | Two medicare diabetes prevention program | 5 | $50.00 |
| G9880 | The mdpp beneficiary achieved at least 5% weight loss | 6 | $121.00 |
| S9325 | Home infusion therapy, pain management infusion | 7 | $37.51 |
| S9345 | Home infusion therapy | 5 | $51.51 |
| S9372 | Home therapy; intermittent anticoagulant injection therapy | 5 | $25.00 |
| S9374 | Home infusion therapy, hydration therapy; one liter per day | 10 | $29.72 |
| S9494 | Home infusion therapy, antibiotic, antiviral | 10 | $33.26 |
| S9537 | Home therapy; hematopoietic hormone injection therapy (e.g. | 7 | $15.00 |
| S9558 | Home injectable therapy; growth hormone | 5 | $10.00 |
| S9560 | Home injectable therapy; hormonal therapy (e.g.; leuprolide | 5 | $20.00 |
What the other line covers
The other line groups the codes billed mostly by providers. Across the 51 state programs we cover, 19 codes in this line have a published fee-for-service rate in five or more states. By code set, the line is made up of 8 HCPCS Level II professional services codes, 8 HCPCS Level II temporary national codes, 2 revenue codes and 1 CPT medicine code.
How to read the index
- Code opens the code's page: every state's rate ranked, the unit, a per-hour figure for timed codes, the managed-care rule and a Medicare comparison where the units match.
- States is the number of state Medicaid programs that publish a fee-for-service rate for the code. A higher count makes the median more representative.
- Median rate is the middle published amount across those states, in the units they use. When states publish a code in different units, the median mixes them, so open the code before relying on it.
Why other rates differ between states
- Each state sets its own fee schedule and updates it on its own budget cycle, so two states can price the same service from different base years.
- Some states tie their rates to a percentage of a Medicare amount; others keep a schedule of their own that changes only when the legislature funds an increase.
- States pay different amounts by provider type, setting and program, and the published rate may already include or exclude add-ons that another state pays separately.
- Rate studies, settlements and targeted increases for workforce shortages move individual services out of step with the rest of a state's schedule.
Billing and units
This service is billed in the unit the state's schedule defines.
Frequently asked questions
How many other codes have Medicaid rates here?
19 codes with a published fee-for-service rate in at least five state Medicaid programs. The typical code in this line is published by 5 states.
Which other codes are published by the most states?
90999 (13 states), S9374 (10 states), S9494 (10 states), S9325 (7 states) and S9537 (7 states).
Can I compare the median rates in this list?
Only with care. Each median is taken across the states that publish the code, in the units they publish it in. Open a code to see the unit each state uses and whether the code is ranked like-for-like.
How are other services billed?
This service is billed in the unit the state's schedule defines.
Where do these rates come from?
From each state's official Medicaid fee schedules, rate notices and provider bulletins. Every rate on a code page links to its source document and effective date.