The North Dakota Medicaid fee schedule pays $105.14 for code 99213, a level-3 return office visit, effective July 1, 2026. That is sixth of 46 states, well above the $75.27 national median and above Medicare's $93.41. North Dakota ranks in the top ten on nearly every common physician, therapy and behavioral health code, and it raised rates twice in 2026. The clear exception is technician-level ABA.
MedicaidRate holds 19,715 current North Dakota Medicaid reimbursement rates across 101 service categories, compiled from 41 official ND Medicaid publications. Our history for North Dakota begins in 2023, so year-over-year comparisons cover the most recent rate cycles. Every rate links to its source; see our methodology.
The core document is the ND Medicaid Professional (General) Services Fee Schedule, with data updated as of July 1, 2026. Alongside it:
- ND Medicaid DME and Supplies Fee Schedule and ND Medicaid Dental Services Fee Schedule, both updated July 1, 2026
- ND Medicaid Basic Care Fee Schedule, effective July 1, 2026
- ND PDPM Case Mix Values, the classifications and case mix index values used for nursing facilities
- DD Rate Matrix - Fully Loaded Hour Value, known as "The Brick", which prices developmental disability services
Nursing facilities are unusually prominent in the dataset, with 1,880 rates, behind only physician services (7,162) and hospital outpatient (4,059).
Of 19,715 rates, 19,436 belong to North Dakota Medicaid (fee-for-service). The rest are home and community programs: the Traditional IID/DD HCBS Waiver (ND.0037), Adults and Aging Qualified Service Provider (QSP) rates, the 1915(i) behavioral health state plan option, the aged and physically disabled waiver (ND.0273), and SPED / Expanded SPED, a state-funded program that is not Medicaid.
A fee schedule is a list of maximum allowable amounts: one dollar figure per billing code, sometimes split by modifier or provider type. When a North Dakota Medicaid member is seen under fee-for-service, the state pays the lower of the provider's billed charge and the scheduled amount. That is why a practice's own charge master rarely changes what it is paid, while the schedule does.
Units matter as much as the dollar figure
Codes in the professional schedule are priced in different units. Office visits, evaluations and speech therapy under 92507 are paid per service. Psychotherapy codes are tied to session length, so 90837 is an hour and 90834 is a shorter session. Therapy procedures like 97110, ABA codes and most home and community services are paid per 15-minute unit. A $10.81 rate and a $105.14 rate are not comparable until both are put on the same footing, which is why we show hourly equivalents for timed codes.
Modifiers and provider levels
Some codes carry modifiers that change payment or describe who delivered the service. The January 2026 therapy clarification on 92507, which addressed reduced- and increased-service modifiers, is an example: the same code can pay differently depending on how it is reported. In ABA, provider level is built into the code itself, with technician work under 97153 and analyst work under 97155 and 97151.
| Code | Service | ND rate | National median | Rank |
|---|---|---|---|---|
| 99213 | Return visit, level 3 | $105.14 | $75.27 | 6 of 46 |
| 99214 | Return visit, level 4 | $149.45 | $108.69 | 6 of 46 |
| 90837 | Psychotherapy, one hour | $187.37 | $132.38 | 7 of 48 |
| 92507 | Speech therapy session | $85.24 | $62.12 | 6 of 44 |
| A0427 | ALS ambulance | $626.51 | $387.24 | 5 of 44 |
| 97153 | ABA by technician, 15 min | $10.81 | $15.86 | 38 of 42 |
Office visits and preventive care
The consistency is striking. Every office visit code ranks between fifth and eighth, and each sits above Medicare: 99215 pays $211.78 against $188.22, and new-patient 99204 pays $194.13 against $172.60. Emergency department code 99285 pays $181.74 (sixth of 48), and the adult preventive visit under 99396 pays $142.31 (fifth of 46). Few states pay Medicaid primary care above Medicare; North Dakota does so across the whole visit ladder.
Behavioral health and therapy
Behavioral health follows the same pattern. Code 90834 pays $127.67 (eighth of 47) and 90791 pays $194.50 (sixth of 44), both above Medicare. Speech therapy under 92507 pays $85.24, above Medicare's $75.96.
Ambulance
For ambulance services, the $626.51 ALS rate is fifth in the nation, well clear of the $387.24 median. For services that depend on long rural transports, this is one of the more favorable schedules in the country.
North Dakota prices ABA unevenly. Technician-delivered 97153 pays $43.24 an hour, 38th of 42 states and 31.8% below the median. Analyst-directed 97155 and assessment code 97151 both pay $31.76 per 15 minutes ($127.04 an hour), ranking 13th and 18th.
The practical effect depends on staffing model. Most ABA programs bill far more technician hours than analyst hours, because direct one-on-one treatment is delivered by technicians under analyst supervision. A provider whose model leans on technician hours will find North Dakota much less attractive than the physician rankings suggest, while one with a higher share of supervision, assessment and caregiver training time will see a better blended rate. Before opening in the state, model the expected mix of 97153 and 97155 units rather than looking at either rate alone. See the North Dakota ABA Medicaid rates page and the national ABA Medicaid rates by state.
- Physical therapy: 97110 pays $129.16 an hour, fifth of 49 and 34.5% above the median, at 112% of Medicare. See North Dakota therapy Medicaid rates.
- Personal care: agency T1019 pays $38.36 an hour, sixth of 27 and 25.7% above the median. See North Dakota home care rates.
- IDD: in-home supports under S5125 pay $41.72 an hour, 10th of 29 and 19.5% above the median. See North Dakota IDD Medicaid rates.
- Skilled nursing: $393.14 a day, effective January 1, 2026. See North Dakota nursing home rates.
- Home health: $77.36 per day under T1030.
Read together, these show a state that pays above the median for most clinical and home-based services. The outliers are technician ABA and base personal care units, which is where providers should look hardest at margins.
North Dakota's published rates are overwhelmingly fee-for-service. Only two service lines have a managed-care rule on record, and both are the same: for hospital inpatient and hospital outpatient services, the state sets the rate plans pay. No state directed payment programs are on record.
Named arrangements in state documents include Blue Cross Blue Shield of North Dakota, Northland PACE, and Primary Care Case Management (PCCM). SPA ND-26-0010, approved by CMS on August 13, 2026, revised the PACE rate development methodology effective July 1, 2026. See the North Dakota managed care page.
What this means for contracting
For most providers, the published schedule is the payment, not a starting point for negotiation. That makes North Dakota simpler than heavily managed-care states: the rate on the schedule is what a claim pays, and changes arrive through the state's January and July updates rather than through individual plan contracts. Hospitals dealing with a plan should expect the state-set rate to govern.
Both 2026 rate cycles, January 1 and July 1, were increases:
- State plan changes for January 1, 2026: a 3.2% increase.
- State plan changes and fee schedules for July 1, 2026: a 2.0% increase, posted to the website July 18, 2026.
- Therapy policy update, effective February 1, 2026, revising physical, occupational and speech therapy policies, with a January 28 clarification on code 92507 modifiers.
- EAPG payment update on the JW modifier for outpatient hospital claims.
- IID/DD HCBS waiver amendment, posted for public notice January 26, 2026.
Two increases in one year compound. A rate that rose 3.2% in January and then 2.0% in July is higher than a single increase of either size, and claims for dates of service after July 1 should be paid at the new amount. Because the July schedules were posted on July 18, some early-July claims may have been processed before the update was loaded. Billing teams should compare remittances for July dates of service against the current schedule and follow the state's adjustment process where payment fell short.
The January date also matters for facility providers. Rule chapters on medical services, nursing facility ratesetting and basic care ratesetting were all amended effective January 1, 2026, alongside state plan amendments for psychiatric residential treatment. Facilities budgeting for the year ahead should treat January as the main reset point and July as the professional fee update.
| State | 99213 | 97153 (15 min) | T1019 (15 min) |
|---|---|---|---|
| North Dakota | $105.14 | $10.81 | $6.98 |
| South Dakota | $89.93 | $21.73 | $11.17 |
| Nebraska | $85.69 | $18.70 | n/a |
| Minnesota | $73.99 | $20.17 | $5.46 |
| Iowa | $43.23 | $28.59 | $10.50 |
North Dakota pays the most in the region for an office visit, ahead of South Dakota and Nebraska and far ahead of Iowa. For technician ABA, it pays the least of these states. Base T1019 personal care at $6.98 per unit trails South Dakota and Iowa, though the agency rate of $9.59 ranks sixth nationally.
For multi-state organizations, the pattern points in two directions. Physician groups, therapy clinics and ambulance services have a clear rate advantage in North Dakota. ABA and personal care agencies working across the Dakotas may find South Dakota the stronger market for the same hours of service.
Budgeting
Build revenue forecasts from your own code mix, not a headline code. Multiply expected units by the scheduled rate for each code, and convert timed codes to the unit the schedule uses. For North Dakota, set two checkpoints in the year, January and July, when rates are most likely to move.
Benchmarking commercial and plan contracts
Because North Dakota Medicaid pays above Medicare on office visits, therapy and psychotherapy, the Medicaid schedule can be a useful floor reference in other payer negotiations. Compare each contracted rate with the Medicaid amount and with the national median; a commercial rate that falls below Medicaid on the same code is a clear point to raise.
Market entry
Rank tells you where a state sits; the gap to the median tells you by how much. A rank of sixth with rates well above the median, as on most physician codes here, is a durable advantage. A rank near the bottom, as on 97153, means a business model needs either a different service mix or lower costs to work.
Most professional rates in North Dakota carry a July 1, 2026 effective date, matching the latest fee schedule release. Some lab codes still carry January 1, 2025 dates from the earlier professional schedule, and DME items such as CPAP devices carry the February 8, 2026 update. Our North Dakota history begins in 2023, which covers several annual cycles and lets you see how each code moved through the January and July updates. Full history by code is part of the MedicaidRate dataset.
All 19,715 current North Dakota rates are compiled from official state Medicaid publications, and each rate links to the document it came from. Named sources include the ND Medicaid Professional (General) Services Fee Schedule, the ND Medicaid DME and Supplies Fee Schedule, the ND Medicaid Dental Services Fee Schedule, the ND Medicaid Basic Care Fee Schedule, the ND Medicaid Rural Health Clinic Fee Schedule, the nursing facility rates by location, the QSP Rates and Rural Differential Rate schedule and the DD Rate Matrix. National medians and ranks compare each code across every state that publishes it. Medicare comparisons use the non-facility rate. See the full methodology page for details.