Delaware Medicaid reimbursement rates
46,693 current fee-for-service and managed-care rates from Delaware Medicaid, across 84 services and 7 programs, normalized by code, provider level and unit. Each links to one of 25 official source documents.
Last retrieved 2026-10-05. History back to 2008-04-01.
- Current rates
- 46,693
- Services
- 84
- Programs
- 7
- Lines with a plan rule
- 2of 18 service lines
By industry
Applied behavior analysis (ABA)Delaware rates, labor costs and changesBehavioral healthDelaware rates, labor costs and changesHome healthDelaware rates, labor costs and changesHome care & personal careDelaware rates, labor costs and changesPrivate duty nursingDelaware rates, labor costs and changesSkilled nursing facilitiesDelaware rates, labor costs and changesHospiceDelaware rates, labor costs and changesIntellectual & developmental disabilitiesDelaware rates, labor costs and changesOutpatient therapy (PT, OT, speech)Delaware rates, labor costs and changes
Delaware rates by service
The median current rate for each service, like-for-like by unit. Follow a service to compare it with every other state.
| Service | Line | Median rate | Unit | Per hour | Variants |
|---|---|---|---|---|---|
| ABA assessment by a behavior analyst | ABA / autism services | $43.76 | 15 min | $175.04 | 3 |
| ABA assessment support by a technician | ABA / autism services | $43.76 | 15 min | $175.04 | 3 |
| ABA parent and caregiver training | ABA / autism services | $31.25 | 15 min | $125.00 | 4 |
| ABA therapy with plan changes by an analyst | ABA / autism services | $30.75 | 15 min | $123.00 | 4 |
| One-on-one ABA therapy by a technician | ABA / autism services | $26.30 | 15 min | $105.18 | 4 |
| Assertive Community Treatment (ACT) team | Behavioral health | $166.70 | day | $173.32 | 72 |
| Behavioral health nursing (RN/LPN) | Behavioral health | $48.82 | hour | $48.82 | 2 |
| Community psychiatric support and treatment (CPST) | Behavioral health | $21.68 | 15 min | $86.70 | 2 |
| Mental health assessment (non-physician) | Behavioral health | $80.29 | — | — | 1 |
| Mental health service plan development | Behavioral health | $20.07 | — | — | 1 |
| Outpatient psychotherapy and diagnostic evaluation | Behavioral health | $86.44 | — | $133.28 | 48 |
| Peer support (behavioral health) | Behavioral health | $3.69 | 15 min | $14.76 | 1 |
| Psychosocial rehabilitation | Behavioral health | $16.64 | 15 min | $66.56 | 3 |
| Residential support for independent living (BH HCBS) | Behavioral health | $262.69 | day | — | 9 |
| Skills training and development | Behavioral health | $29.92 | 15 min | $119.68 | 1 |
| Supported employment (behavioral health) | Behavioral health | $6.81 | 15 min | $27.24 | 5 |
| Dental services | Dental | $373.94 | — | — | 216 |
| Durable medical equipment | Equipment & supplies | $73.08 | — | $148.04 | 2488 |
| Enteral and parenteral nutrition | Equipment & supplies | $17.48 | day | — | 22 |
| Medical supplies | Equipment & supplies | $12.48 | — | — | 898 |
| Orthotics and prosthetics | Equipment & supplies | $574.13 | — | $141.18 | 1419 |
| Assistive technology assessment | Other home & community services | $31.59 | 15 min | $126.36 | 4 |
| Case management / support coordination | Other home & community services | $35.26 | month | $116.94 | 34 |
| Chore services (heavy cleaning, yard work, pest control) | Other home & community services | $6.22 | 15 min | $24.86 | 2 |
| Money management support | Other home & community services | $45.98 | 15 min | $83.60 | 2 |
| Nursing assessment | Other home & community services | $21.18 | — | $78.52 | 4 |
| Prescribed pediatric extended care (medical day care) | Other home & community services | $354.73 | day | — | 12 |
| Respite care (daily) | Other home & community services | $262.69 | day | — | 9 |
| Respite care (hourly) | Other home & community services | $15.00 | hour | $27.92 | 5 |
| Respite in a facility (daily) | Other home & community services | $1,402.87 | day | — | 1 |
| Home health aide visit | Home health | $10.48 | 15 min | $41.92 | 2 |
| Home health nurse visit (RN or LPN) | Home health | $49.07 | 15 min | $196.28 | 4 |
| Home health occupational therapy | Home health | $44.61 | 15 min | $178.44 | 2 |
| Home health physical therapy | Home health | $49.25 | 15 min | $197.00 | 2 |
| Home health speech therapy | Home health | $43.42 | 15 min | $173.68 | 2 |
| Inpatient capital payment (building and equipment) | Hospital inpatient | $347.76 | discharge | — | 14 |
| Inpatient DRG pricing input (outlier, cost ratio, stay) | Hospital inpatient | $15,491.72 | Outlier Threshold (4x Operating Rate) | — | 7 |
| Inpatient hospital stay (hospital-specific rate per discharge) | Hospital inpatient | $3,423.96 | discharge | — | 14 |
| Inpatient operating payment component (per discharge) | Hospital inpatient | $3,062.30 | discharge | — | 14 |
| Inpatient rate add-on (education, wage, directed payment) | Hospital inpatient | $179.52 | discharge | — | 6 |
| Hospital outpatient visit (flat rate per visit type) | Hospital outpatient | $195.77 | visit | — | 27 |
| Outpatient hospital (percent of charges or cost) | Hospital outpatient | $0.4559 | Paid as a Percent of Charges | — | 61 |
| Surgery center facility fee (per procedure) | Hospital outpatient | $1,644.01 | — | — | 21581 |
| Behavior support services (disability waiver) | IDD services | $21.84 | 15 min | $87.36 | 3 |
| Benefits counseling | IDD services | $23.60 | 15 min | $94.40 | 2 |
| Community integration / community access (IDD) | IDD services | $12.47 | 15 min | $49.86 | 6 |
| Day habilitation / day program (IDD) | IDD services | $13.01 | 15 min | $52.02 | 6 |
| Employment exploration | IDD services | $22.92 | 15 min | $91.68 | 1 |
| In-home and community living supports (IDD) | IDD services | $60.49 | hour | $60.49 | 1 |
| Prevocational services | IDD services | $13.01 | 15 min | $52.02 | 6 |
| Residential habilitation / group home supports | IDD services | $41.92 | hour | — | 13 |
| Shared living / host home / family model | IDD services | $269.54 | hour | — | 20 |
| Supported employment (job coaching) | IDD services | $4.52 | 15 min | $18.08 | 25 |
| Clinical lab tests | Lab & pathology | $20.39 | — | — | 1584 |
| Directed payment: plan payment level (% of benchmark) | Other | $58.05 | % of surveyed nursing facility other-payer rates | — | 30 |
| School-based Medicaid service (billed by a school district) | Other | $24.74 | 30 min | $94.56 | 46 |
| Personal care / attendant care (hourly) | Personal care & attendant | $29.51 | 15 min | $34.43 | 6 |
| Physician-administered drugs (J-codes) | Pharmacy | $382.76 | — | — | 7 |
| Private duty nursing (hourly shifts) | Private duty nursing | $45.24 | hour | $45.24 | 6 |
| Waiver nursing (RN or LPN, by the 15 minutes) | Private duty nursing | $20.86 | 15 min | $83.44 | 2 |
| Anesthesia base units (per procedure) | Physician & professional | $5.00 | RVU | — | 277 |
| Anesthesia conversion factor | Physician & professional | $20.51 | — | — | 277 |
| Physician and practitioner services (fee schedule) | Physician & professional | $449.48 | — | $103.04 | 13786 |
| Imaging and radiology | Radiology | $71.63 | — | — | 3292 |
| Cognitive rehabilitation therapy | Therapy (PT/OT/speech) | $19.82 | 15 min | $79.28 | 4 |
| Occupational therapy | Therapy (PT/OT/speech) | $34.17 | 15 min | $136.68 | 5 |
| Occupational therapy evaluation | Therapy (PT/OT/speech) | $98.17 | — | — | 9 |
| Orientation and mobility training (vision loss) | Therapy (PT/OT/speech) | $31.59 | 15 min | $126.36 | 2 |
| Orthotic and prosthetic fitting and training | Therapy (PT/OT/speech) | $44.87 | 15 min | $179.48 | 7 |
| Physical therapy | Therapy (PT/OT/speech) | $28.76 | 15 min | $115.02 | 6 |
| Physical therapy evaluation | Therapy (PT/OT/speech) | $95.90 | — | — | 9 |
| Speech-generating device evaluation | Therapy (PT/OT/speech) | $119.69 | — | — | 2 |
| Speech-generating device therapy | Therapy (PT/OT/speech) | $100.09 | — | — | 2 |
| Speech-language evaluation | Therapy (PT/OT/speech) | $108.01 | — | — | 12 |
| Speech-language therapy | Therapy (PT/OT/speech) | $74.43 | — | — | 3 |
| Swallowing and feeding evaluation | Therapy (PT/OT/speech) | $56.64 | — | — | 3 |
| Swallowing and feeding therapy | Therapy (PT/OT/speech) | $82.21 | — | — | 3 |
| Air ambulance transport | Transportation | $5,020.62 | — | — | 1 |
| Ambulance mileage | Transportation | $32.89 | mile | — | 1 |
| Ground ambulance transport | Transportation | $191.89 | — | — | 4 |
| Non-emergency medical transportation (NEMT) | Transportation | $10.56 | mile | — | 8 |
| Waiver transportation (to community activities) | Transportation | $20.96 | day | — | 9 |
| Eyeglasses and contact lenses | Vision & hearing | $105.92 | — | — | 189 |
| Hearing aids and hearing services | Vision & hearing | $22.72 | — | — | 3 |
Most-compared billing codes in Delaware
Where Delaware ranks among states for codes published widely. Rank 1 = highest rate.
| Code | Service | Delaware | All-state median | Rank |
|---|---|---|---|---|
| 10005 | Physician and practitioner services (fee schedule) | $128.36 | $88.19 | 6 of 50 |
| 10006 | Physician and practitioner services (fee schedule) | $58.44 | $46.23 | 7 of 50 |
| 10007 | Physician and practitioner services (fee schedule) | $333.62 | $203.95 | 5 of 50 |
| 10008 | Physician and practitioner services (fee schedule) | $137.00 | $95.09 | 9 of 50 |
| 10009 | Physician and practitioner services (fee schedule) | $400.28 | $276.55 | 9 of 50 |
| 10010 | Physician and practitioner services (fee schedule) | $227.96 | $157.44 | 9 of 50 |
| 10021 | Physician and practitioner services (fee schedule) | $98.14 | $73.91 | 8 of 50 |
| 10030 | Physician and practitioner services (fee schedule) | $602.32 | $401.12 | 9 of 50 |
| 10060 | Physician and practitioner services (fee schedule) | $124.79 | $88.74 | 6 of 50 |
| 10061 | Physician and practitioner services (fee schedule) | $213.49 | $153.30 | 6 of 50 |
| 10080 | Physician and practitioner services (fee schedule) | $261.06 | $129.47 | 6 of 50 |
| 10081 | Physician and practitioner services (fee schedule) | $367.99 | $200.51 | 6 of 50 |
| 10120 | Physician and practitioner services (fee schedule) | $152.58 | $98.41 | 6 of 50 |
| 10121 | Physician and practitioner services (fee schedule) | $266.86 | $171.22 | 6 of 50 |
| 10140 | Physician and practitioner services (fee schedule) | $169.06 | $109.79 | 6 of 50 |
| 10160 | Physician and practitioner services (fee schedule) | $127.64 | $86.10 | 6 of 50 |
| 10180 | Physician and practitioner services (fee schedule) | $278.89 | $182.52 | 6 of 50 |
| 11000 | Physician and practitioner services (fee schedule) | $57.43 | $38.05 | 8 of 50 |
| 11001 | Physician and practitioner services (fee schedule) | $26.27 | $18.34 | 8 of 50 |
| 11004 | Physician and practitioner services (fee schedule) | $488.34 | $437.24 | 15 of 50 |
| 11005 | Physician and practitioner services (fee schedule) | $668.12 | $594.32 | 13 of 50 |
| 11006 | Physician and practitioner services (fee schedule) | $602.71 | $545.22 | 15 of 50 |
| 11008 | Physician and practitioner services (fee schedule) | $235.81 | $211.94 | 14 of 50 |
| 11010 | Physician and practitioner services (fee schedule) | $454.47 | $286.71 | 6 of 50 |
| 11011 | Physician and practitioner services (fee schedule) | $520.29 | $326.17 | 6 of 50 |
| 11012 | Physician and practitioner services (fee schedule) | $664.79 | $442.71 | 6 of 50 |
| 11042 | Physician and practitioner services (fee schedule) | $128.88 | $84.55 | 6 of 50 |
| 11043 | Physician and practitioner services (fee schedule) | $232.45 | $167.89 | 7 of 50 |
| 11044 | Physician and practitioner services (fee schedule) | $310.83 | $227.02 | 7 of 50 |
| 11055 | Physician and practitioner services (fee schedule) | $68.01 | $40.24 | 6 of 50 |
| 11056 | Physician and practitioner services (fee schedule) | $78.74 | $47.35 | 6 of 50 |
| 11057 | Physician and practitioner services (fee schedule) | $86.23 | $52.53 | 6 of 50 |
| 11102 | Physician and practitioner services (fee schedule) | $92.68 | $71.28 | 8 of 50 |
| 11103 | Physician and practitioner services (fee schedule) | $47.30 | $36.83 | 7 of 50 |
| 11104 | Physician and practitioner services (fee schedule) | $117.58 | $84.93 | 7 of 50 |
| 11105 | Physician and practitioner services (fee schedule) | $58.57 | $42.80 | 7 of 50 |
| 11106 | Physician and practitioner services (fee schedule) | $146.70 | $101.36 | 6 of 50 |
| 11107 | Physician and practitioner services (fee schedule) | $68.68 | $50.82 | 7 of 50 |
| 11300 | Physician and practitioner services (fee schedule) | $93.62 | $55.51 | 6 of 50 |
| 11301 | Physician and practitioner services (fee schedule) | $112.80 | $67.43 | 6 of 50 |
Managed care in Delaware
5 plans on record, 30 state-directed payment records.
Who sets the rate, line by line →Recent rate changes and notices
Frequently asked questions
Where does Delaware publish its Medicaid fee schedules?
Delaware publishes rates across 25 official documents (fee schedules, rate notices and bulletins). Every rate on this page links to its source document.
How many Medicaid rates does Delaware publish?
46,693 rates are current across 84 services and 7 programs, with 119,292 versions on record since 2008-04-01.
Do Delaware Medicaid managed-care plans pay the fee schedule?
For 2 of 18 service lines, plan contracts or state law set a rule plans must follow (a floor, a state-set rate or a required pass-through). For the rest, plans negotiate. See the managed-care page for each line's rule and citation.
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Your Delaware rate cardYour codes, what Delaware pays, what plans must pay, and every change in 2026.