Behavioral health Medicaid rates in North Dakota put the state near the top for outpatient therapy and right at the national median for community services. North Dakota Medicaid pays $118.28 on family therapy code 90846, which ranks 3rd of 28 states and sits 41.9% above the $83.33 national median. Only California and New Mexico pay more on this measure.
Every North Dakota behavioral health rate on this page took effect on the same date, 2026-07-01, so the schedule is current across the board. That reflects a steady twice-a-year update cycle that sets North Dakota apart from states whose behavioral health rates sit unchanged for years. Rates are compiled from official North Dakota Medicaid publications, and each rate on the North Dakota Medicaid rates hub links to its source document.
| Service | Code | ND rate | Per hour | Rank | vs median |
|---|---|---|---|---|---|
| Outpatient psychotherapy and evaluation | 90846 | $118.28 | n/a | 3 of 28 | 41.9% |
| Therapeutic behavioral services | H2019 | $21.97 per 15 min | $87.88 | 14 of 28 | 0.1% |
| Skills training and development | H2014 | $12.83 per 15 min | $51.32 | 15 of 33 | 0.2% |
| Community-based wraparound | H2021 | $11.84 per 15 min | $47.36 | 9 of 11 | -47.7% |
The pattern is unusual. Two community services, H2019 and H2014, land within a fraction of a percent of the national median. Therapy sits well above it, and wraparound sits well below. These are the ranked comparison lines; the full North Dakota dataset holds all 19,715 current Medicaid rates, each linked to its source.
The 90846 rate of $118.28 places North Dakota behind California ($302.03) and New Mexico ($144.88), and ahead of Nebraska ($115.68) and Wisconsin ($95.02). The lowest states on this measure are Iowa at $58.46, Pennsylvania at $26.25 and Missouri at $20.33.
North Dakota also pays $156.97 per occurrence on H0031 for a non-physician mental health assessment. That rate is not ranked against other states because of its per-occurrence unit, but it is above the $125.00 national median for the service.
Why the therapy rate matters most
For an outpatient practice, a therapy rate in the top three is a meaningful advantage. Psychotherapy fills most billable clinician time, so a rate well above the median lifts the whole practice's revenue per clinician. The same strength shows across the standard session codes such as 90837, which are listed on the state hub. A practice weighing whether to accept Medicaid in North Dakota faces a far smaller gap between Medicaid and commercial payment than it would in most states.
North Dakota publishes its behavioral health rates inside the ND Medicaid Professional (General) Services Fee Schedule rather than in a separate behavioral health manual. Each line carries a code, a unit and a rate. Therapy codes are paid per service, assessment on H0031 per occurrence, and the community codes in 15-minute units. Converting each to an hourly figure, as the table does, is the only fair way to compare them with each other and with wages.
Because every rate shares the same 2026-07-01 effective date, a North Dakota provider can treat the schedule as a single current document. That is simpler than in states where some lines date back years and others were updated last quarter. The 1915(i) behavioral health services sit in their own program with their own codes, so agencies delivering 1915(i) supports should check that program's lines separately.
North Dakota's published coverage data shows no prior authorization rules and no frequency limits on 90785, 90791, 90792, 90832, 90833, 90834, 90836 or 90837, nor on the family, group and crisis codes. A strong rate with no authorization step on the core codes keeps both revenue and administrative cost in a provider's favor.
Removing authorization work has real value for small practices. Front-desk and billing staff spend no time requesting approvals, sessions can start immediately after evaluation, and there is no risk of a gap between an expired authorization and a renewed one. Documentation of medical necessity is still required, and a practice should keep treatment plans current so that records support every session billed.
North Dakota's therapeutic behavioral services and skills training rates sit almost exactly on the national midpoint. H2019 pays $87.88 an hour against an $87.82 median, and H2014 pays $51.32 an hour against a $51.20 median.
The labor economics differ between the two:
- Therapeutic behavioral services. At $87.88 an hour and a $19.21 median psychiatric technician wage, wages take 31.1% of the rate. The margin after loaded wages is $60.58 an hour.
- Skills training and development. At $51.32 an hour, the same wage takes 53.2% of the rate, leaving a margin of $24.02 an hour.
H2019 is the more sustainable line for a community agency in North Dakota. Skills training covers wages with room to spare, but travel time, documentation and missed visits eat into that $24.02 quickly. In a state with long distances between communities, routing staff efficiently is as important as the rate itself.
Community-based wraparound services on H2021 pay $11.84 per 15 minutes, or $47.36 an hour. That ranks 9th of 11 states and sits 47.7% below the $90.48 national median. North Dakota is one of the three lowest states on this service, alongside New Jersey ($39.08) and Utah ($19.76). Louisiana pays $710.72 an hour and Virginia $280.00.
Wraparound is often staffed by the same workers who deliver H2019 and H2014, so an agency that blends these services will find wraparound the least profitable hour on its schedule. Agencies should assign wraparound to staff whose wage fits the rate and keep higher-paid clinicians focused on therapy, where the rate supports their cost.
In North Dakota, several behavioral health wages exceed the national figures (May 2025):
- Mental health counselor: $33.00, against $28.53 nationally
- Mental health social worker: $29.32, against $28.98
- Clinical psychologist: $55.83, against $48.36
- Nurse practitioner: $62.53, against $63.61
- Psychiatric technician: $19.21, against $21.70
Higher counselor and psychologist wages offset some of the therapy rate advantage, but the 90846 rate is 41.9% above the median while counselor wages are only modestly above theirs. Psychiatric technicians, by contrast, earn less than the national median, which is why the community services above produce positive margins at median rates.
North Dakota publishes regular state plan updates tied to January and July:
- Public Notice - Medicaid State Plan Changes for July 1, 2026 proposed a 2.0% change effective 2026-07-01, the same date as every rate above.
- Public Notice - Medicaid State Plan Changes for Jan. 1, 2026 proposed a 3.2% change effective 2026-01-01.
- Earlier notices proposed 3.0% for January 2025 and 2.0% for July 2025.
What a predictable cycle means for providers
Regular, modest increases are easier to plan around than occasional large ones. A North Dakota provider can expect the schedule to move each January and July and can align staff pay reviews and budgets with those dates. The practical step is to reload the fee schedule after each update and confirm that payers have applied the new rates to dates of service on or after the effective date.
Several approved amendments target services beyond outpatient therapy:
- SPA ND-26-0002 implements a two percent inflationary increase for Psychiatric Residential Treatment Facility services effective 2026-01-01.
- SPA ND-26-0003 reimburses therapeutic leave days for Psychiatric Residential Treatment Facilities, and SPA ND-25-0004 did the same for hospital leave days.
- SPA ND-25-0010, effective 2025-10-01, renews North Dakota's 1915(i) State Plan HCBS benefit; SPA ND-25-0028 corrects the effective date of the 1915(i) payment pages, and SPA ND-25-0023 proposed a rate increase for 1915(i) services.
Paid leave days matter to residential operators, because a bed held for a youth on a home visit or in the hospital otherwise earns nothing while staffing costs continue.
North Dakota's listed programs for behavioral health include North Dakota Medicaid fee-for-service and the North Dakota Medicaid 1915(i) state plan home and community-based behavioral health services program. The state's managed care rules are classified only for hospital services, not behavioral health. Our behavioral health data counts 5 plans, and the plans named in the state data include Blue Cross Blue Shield of North Dakota and Primary Care Case Management (PCCM). The North Dakota managed care page has the detail.
- Plan around January and July. Budget each half-year from the most recent update, and verify remittances after each one.
- Lead with therapy. Outpatient psychotherapy is where North Dakota pays furthest above the median.
- Match staff to rate. Use technician-level staff for H2019, H2014 and wraparound; keep licensed clinicians on therapy.
- Benchmark regionally. The Minnesota and South Dakota hubs show neighboring schedules.
National medians for every service group are on the behavioral health Medicaid rates by state overview, and plans for the full dataset are on the pricing page.
Rates are compiled from official North Dakota Medicaid publications, including the ND Medicaid Professional (General) Services Fee Schedule updated as of 2026-07-01. Each rate links to its source document, and North Dakota's history in our data goes back to 2023. Comparison groups match services across codes, hourly figures are converted from the published unit, and ranks include only states with a comparable rate. Wage figures are May 2025 medians. See the methodology page.