Pennsylvania Medicaid reimbursement rates
49,804 current fee-for-service and managed-care rates from Pennsylvania Medicaid, across 104 services and 25 programs, normalized by code, provider level and unit. Each links to one of 305 official source documents.
Last retrieved 2026-10-02. History back to 1983-03-12.
- Current rates
- 49,804
- Services
- 104
- Programs
- 25
- Lines with a plan rule
- 3of 20 service lines
By industry
Applied behavior analysis (ABA)Pennsylvania rates, labor costs and changesBehavioral healthPennsylvania rates, labor costs and changesHome healthPennsylvania rates, labor costs and changesHome care & personal carePennsylvania rates, labor costs and changesPrivate duty nursingPennsylvania rates, labor costs and changesSkilled nursing facilitiesPennsylvania rates, labor costs and changesHospicePennsylvania rates, labor costs and changesIntellectual & developmental disabilitiesPennsylvania rates, labor costs and changesOutpatient therapy (PT, OT, speech)Pennsylvania rates, labor costs and changes
Pennsylvania 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 | $23.41 | 15 min | $93.64 | 18 |
| ABA assessment support by a technician | ABA / autism services | $15.76 | 15 min | $63.04 | 16 |
| ABA parent and caregiver training | ABA / autism services | $23.41 | 15 min | $93.64 | 16 |
| ABA therapy with plan changes by an analyst | ABA / autism services | $23.41 | 15 min | $93.64 | 18 |
| Group ABA therapy led by a technician | ABA / autism services | $8.15 | 15 min | $32.60 | 21 |
| Group ABA therapy led by an analyst | ABA / autism services | $8.15 | 15 min | $32.60 | 21 |
| One-on-one ABA therapy by a technician | ABA / autism services | $14.25 | 15 min | $56.98 | 18 |
| Ambulatory withdrawal management (detox) | Behavioral health | $106.35 | hour | $106.35 | 1 |
| Behavioral health services (fee schedule) | Behavioral health | $14.00 | 15 min | $80.00 | 117 |
| Certified community behavioral health clinic (CCBHC) rate | Behavioral health | $896.18 | month | — | 7 |
| Community-based wraparound services | Behavioral health | $2.08 | 15 min | $8.32 | 28 |
| Intensive outpatient program (behavioral health) | Behavioral health | $11.57 | 15 min | $46.28 | 1 |
| Medically supervised inpatient withdrawal (per day) | Behavioral health | $415.24 | day | — | 1 |
| Mental health assessment (non-physician) | Behavioral health | $26.25 | — | — | 39 |
| Mental health counseling | Behavioral health | $11.83 | 15-minute unit | $47.32 | 21 |
| Mental health service plan development | Behavioral health | $17.22 | — | $68.86 | 18 |
| Multisystemic therapy for youth | Behavioral health | $28.44 | 15 min | $113.76 | 9 |
| Outpatient psychotherapy and diagnostic evaluation | Behavioral health | $39.00 | — | $52.00 | 177 |
| Peer support (behavioral health) | Behavioral health | $10.00 | 15 min | $40.00 | 13 |
| Psychiatric partial hospitalization | Behavioral health | $10.74 | 15 min | $42.96 | 1 |
| Skills training and development | Behavioral health | $2.50 | 15 min | $10.00 | 9 |
| SUD residential treatment (per day) | Behavioral health | $260.65 | day | — | 3 |
| Therapeutic behavioral services | Behavioral health | $20.79 | 15 min | $83.16 | 19 |
| FQHC / RHC visit (PPS or APM rate) | Clinics (FQHC/RHC) | $35.00 | — | — | 24 |
| Dental services | Dental | $776.00 | — | — | 135 |
| Durable medical equipment | Equipment & supplies | $170.82 | — | $25.00 | 4548 |
| Enteral and parenteral nutrition | Equipment & supplies | $14.73 | — | — | 143 |
| Medical supplies | Equipment & supplies | $4.73 | — | — | 2061 |
| Orthotics and prosthetics | Equipment & supplies | $254.25 | — | $30.00 | 4820 |
| Adult day services | Other home & community services | $37.51 | 15-minute unit | — | 66 |
| Case management / support coordination | Other home & community services | $46.20 | 15-minute unit | $75.12 | 101 |
| Chore services (heavy cleaning, yard work, pest control) | Other home & community services | $16.42 | hour | $16.42 | 2 |
| Community integration (older adults / disability waivers) | Other home & community services | $6.52 | 15 min | $26.08 | 12 |
| Community transition (moving out of an institution) | Other home & community services | $24.12 | 15-minute unit | — | 2 |
| Family caregiver training and support | Other home & community services | $19.56 | 15-minute unit | — | 6 |
| Financial management services (self-direction) | Other home & community services | $100.00 | Per Person Per Month | — | 8 |
| HCBS provider incentive payment | Other home & community services | $15,000.00 | paid when outcome achieved | — | 2 |
| Independent living skills training | Other home & community services | $14.12 | 15 min | $56.48 | 28 |
| Nursing assessment | Other home & community services | $175.00 | — | — | 16 |
| Respite care (daily) | Other home & community services | $556.30 | day unit | — | 242 |
| Respite care (hourly) | Other home & community services | $4.80 | 15 minute unit | $18.52 | 101 |
| Self-direction coaching / supports broker | Other home & community services | $8.26 | 15 minute unit | — | 8 |
| Service planning meeting | Other home & community services | $95.00 | per unit | — | 5 |
| Transitional care coordination (children's waiver) | Other home & community services | $19.50 | 15 min | $77.98 | 20 |
| Home health aide visit | Home health | $45.00 | 15 min | $180.00 | 34 |
| Home health nurse visit (RN or LPN) | Home health | $16.55 | 15 min | $66.20 | 60 |
| Home health occupational therapy | Home health | $21.29 | 15 min | $85.16 | 18 |
| Home health physical therapy | Home health | $20.20 | 15 min | $80.80 | 18 |
| Home health speech therapy | Home health | $21.72 | 15 min | $86.88 | 18 |
| Home health visit (other or unspecified) | Home health | $12.07 | 30 min | $33.48 | 25 |
| Inpatient DRG relative weight | Hospital inpatient | $1.85 | relative weight | — | 1336 |
| Inpatient hospital stay (DRG base rate) | Hospital inpatient | $63.85 | day | — | 4 |
| Outpatient hospital services (fee schedule) | Hospital outpatient | $38.21 | — | $42.82 | 95 |
| Additional residential staffing | IDD services | $19.79 | 15-minute unit | $29.51 | 57 |
| Behavior support services (disability waiver) | IDD services | $24.70 | 15-minute unit | — | 10 |
| Benefits counseling | IDD services | $10.54 | 15-minute unit | $41.50 | 18 |
| Communication specialist (IDD) | IDD services | $20.64 | 15-minute unit | — | 2 |
| Community integration / community access (IDD) | IDD services | $12.46 | 15 min | $50.40 | 31 |
| Day habilitation / day program (IDD) | IDD services | $19.62 | 15 min | $34.56 | 74 |
| Employment exploration | IDD services | $12.12 | 15 minute unit | $49.02 | 21 |
| Family medical support assistance | IDD services | $20.53 | 15-minute unit | — | 4 |
| In-home and community living supports (IDD) | IDD services | $12.45 | 15 minute unit | — | 36 |
| Job development and self-employment outcome payments | IDD services | $20.13 | 15 minute unit | — | 15 |
| Prevocational services | IDD services | $6.52 | 15 min | $26.08 | 44 |
| Remote supports (technology-based supervision) | IDD services | $65.00 | 15 min | $14.96 | 24 |
| Residential habilitation / group home supports | IDD services | $439.74 | day | — | 383 |
| Residential habilitation room and board fee | IDD services | $26.15 | day | — | 50 |
| Residential provider performance add-on (percent) | IDD services | $4.00 | rate add-on of 3% per individual served | — | 2 |
| Shared living / host home / family model | IDD services | $211.85 | day | — | 87 |
| Supported employment (job coaching) | IDD services | $10.38 | 15 minute unit | $40.58 | 96 |
| Clinical lab tests | Lab & pathology | $15.21 | — | — | 2788 |
| Nursing home minimum-payment component (managed care) | Nursing facility | $22.41 | — | — | 1180 |
| Nursing home stay (daily rate) | Nursing facility | $278.68 | — | — | 1187 |
| Directed payment uniform increase (required MCO uplift) | Other | $131.60 | up to $1,850,000,000 | $5.00 | 34 |
| Companion care | Personal care & attendant | $6.10 | 15 minute unit | — | 12 |
| Home health aide or nurse aide care (hourly) | Personal care & attendant | $27.36 | per unit | — | 1 |
| Homemaker / housekeeping help | Personal care & attendant | $21.31 | hour | $21.31 | 4 |
| Personal care / attendant care (hourly) | Personal care & attendant | $4.88 | 15 min | $19.52 | 81 |
| Physician-administered drugs (J-codes) | Pharmacy | $17.92 | — | — | 128 |
| Nurse shadowing / home care training | Private duty nursing | $50.00 | — | $50.00 | 3 |
| Private duty nursing (hourly shifts) | Private duty nursing | $50.00 | hour | $50.00 | 10 |
| Waiver nursing (RN or LPN, by the 15 minutes) | Private duty nursing | $19.63 | 15-minute unit | $257.96 | 24 |
| Physician and practitioner services (fee schedule) | Physician & professional | $101.48 | — | $67.50 | 24955 |
| Imaging and radiology | Radiology | $31.03 | — | — | 2756 |
| Activity therapy | Therapy (PT/OT/speech) | $11.25 | per 15-minute unit | $45.00 | 25 |
| Cognitive rehabilitation therapy | Therapy (PT/OT/speech) | $18.76 | 15 min | $75.04 | 32 |
| Nutrition counseling (dietitian) | Therapy (PT/OT/speech) | $15.00 | 15-minute unit | $55.08 | 64 |
| Occupational therapy | Therapy (PT/OT/speech) | $13.00 | 15-minute unit | $52.00 | 16 |
| Occupational therapy evaluation | Therapy (PT/OT/speech) | $61.73 | — | — | 66 |
| Orientation and mobility training (vision loss) | Therapy (PT/OT/speech) | $25.45 | 15-minute unit | — | 2 |
| Other therapy services | Therapy (PT/OT/speech) | $12.90 | 30 min | $46.04 | 41 |
| Physical therapy | Therapy (PT/OT/speech) | $16.75 | 15-minute unit | $66.00 | 26 |
| Physical therapy evaluation | Therapy (PT/OT/speech) | $63.61 | — | — | 65 |
| Speech-language evaluation | Therapy (PT/OT/speech) | $74.97 | — | — | 67 |
| Speech-language therapy | Therapy (PT/OT/speech) | $21.70 | 15-minute unit | — | 34 |
| Swallowing and feeding evaluation | Therapy (PT/OT/speech) | $38.90 | — | — | 11 |
| Swallowing and feeding therapy | Therapy (PT/OT/speech) | $47.74 | — | — | 5 |
| Air ambulance transport | Transportation | $5,589.00 | — | — | 4 |
| Ambulance mileage | Transportation | $13.20 | mile | — | 50 |
| Ground ambulance transport | Transportation | $614.74 | — | — | 6 |
| Non-emergency medical transportation (NEMT) | Transportation | $10.00 | — | — | 41 |
| Waiver transportation (to community activities) | Transportation | $36.54 | per trip | — | 9 |
| Eyeglasses and contact lenses | Vision & hearing | $7.00 | — | — | 87 |
| Hearing aids and hearing services | Vision & hearing | $603.60 | — | — | 486 |
Most-compared billing codes in Pennsylvania
Where Pennsylvania ranks among states for codes published widely. Rank 1 = highest rate.
| Code | Service | Pennsylvania | All-state median | Rank |
|---|---|---|---|---|
| 10004 | Physician and practitioner services (fee schedule) | $35.52 | $35.52 | 10 of 19 |
| 10005 | Physician and practitioner services (fee schedule) | $59.78 | $60.63 | 11 of 19 |
| 10006 | Physician and practitioner services (fee schedule) | $40.71 | $39.90 | 9 of 19 |
| 10007 | Physician and practitioner services (fee schedule) | $76.74 | $76.74 | 10 of 19 |
| 10008 | Physician and practitioner services (fee schedule) | $50.01 | $46.94 | 8 of 19 |
| 10009 | Physician and practitioner services (fee schedule) | $93.03 | $93.03 | 10 of 19 |
| 10010 | Physician and practitioner services (fee schedule) | $67.99 | $65.32 | 9 of 19 |
| 10021 | Physician and practitioner services (fee schedule) | $62.24 | $49.77 | 6 of 19 |
| 10030 | Physician and practitioner services (fee schedule) | $125.28 | $119.43 | 7 of 19 |
| 10035 | Physician and practitioner services (fee schedule) | $70.26 | $70.26 | 10 of 19 |
| 10036 | Physician and practitioner services (fee schedule) | $35.41 | $35.41 | 10 of 19 |
| 10060 | Physician and practitioner services (fee schedule) | $23.50 | $76.16 | 19 of 19 |
| 10061 | Physician and practitioner services (fee schedule) | $52.50 | $129.16 | 17 of 19 |
| 10080 | Physician and practitioner services (fee schedule) | $36.00 | $78.73 | 18 of 19 |
| 10081 | Physician and practitioner services (fee schedule) | $112.50 | $127.86 | 14 of 19 |
| 10120 | Physician and practitioner services (fee schedule) | $30.50 | $77.44 | 19 of 19 |
| 10121 | Physician and practitioner services (fee schedule) | $65.00 | $135.29 | 17 of 19 |
| 10140 | Physician and practitioner services (fee schedule) | $23.50 | $86.45 | 19 of 19 |
| 10160 | Physician and practitioner services (fee schedule) | $24.00 | $69.52 | 18 of 19 |
| 10180 | Physician and practitioner services (fee schedule) | $154.29 | $148.10 | 6 of 19 |
| 11000 | Physician and practitioner services (fee schedule) | $29.30 | $24.52 | 5 of 19 |
| 11001 | Physician and practitioner services (fee schedule) | $14.81 | $12.36 | 5 of 19 |
| 11004 | Physician and practitioner services (fee schedule) | $437.26 | $437.21 | 9 of 19 |
| 11005 | Physician and practitioner services (fee schedule) | $594.74 | $573.02 | 8 of 19 |
| 11006 | Physician and practitioner services (fee schedule) | $548.28 | $542.16 | 9 of 19 |
| 11008 | Physician and practitioner services (fee schedule) | $222.59 | $206.56 | 5 of 19 |
| 11010 | Physician and practitioner services (fee schedule) | $250.07 | $225.24 | 6 of 19 |
| 11011 | Physician and practitioner services (fee schedule) | $268.00 | $229.46 | 7 of 19 |
| 11012 | Physician and practitioner services (fee schedule) | $392.66 | $326.26 | 5 of 19 |
| 11042 | Physician and practitioner services (fee schedule) | $33.00 | $50.80 | 16 of 19 |
| 11043 | Physician and practitioner services (fee schedule) | $33.00 | $134.21 | 18 of 19 |
| 11044 | Physician and practitioner services (fee schedule) | $33.00 | $182.12 | 18 of 19 |
| 11055 | Physician and practitioner services (fee schedule) | $20.00 | $14.80 | 5 of 19 |
| 11056 | Physician and practitioner services (fee schedule) | $29.68 | $20.38 | 5 of 19 |
| 11057 | Physician and practitioner services (fee schedule) | $38.94 | $26.13 | 5 of 19 |
| 11102 | Physician and practitioner services (fee schedule) | $32.23 | $32.23 | 10 of 19 |
| 11103 | Physician and practitioner services (fee schedule) | $18.65 | $18.65 | 10 of 19 |
| 11104 | Physician and practitioner services (fee schedule) | $40.43 | $40.43 | 10 of 19 |
| 11105 | Physician and practitioner services (fee schedule) | $22.05 | $22.05 | 10 of 19 |
| 11106 | Physician and practitioner services (fee schedule) | $49.21 | $49.21 | 10 of 19 |
Managed care in Pennsylvania
18 plans on record, 34 state-directed payment records.
Who sets the rate, line by line →Recent rate changes and notices
Frequently asked questions
Where does Pennsylvania publish its Medicaid fee schedules?
Pennsylvania publishes rates across 305 official documents (fee schedules, rate notices and bulletins). Every rate on this page links to its source document.
How many Medicaid rates does Pennsylvania publish?
49,804 rates are current across 104 services and 25 programs, with 127,874 versions on record since 1983-03-12.
Do Pennsylvania Medicaid managed-care plans pay the fee schedule?
For 3 of 20 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.
Other states
Your Pennsylvania rate cardYour codes, what Pennsylvania pays, what plans must pay, and every change in 2026.