Texas Medicaid reimbursement rates
139,525 current fee-for-service and managed-care rates from Texas Medicaid, across 115 services and 33 programs, normalized by code, provider level and unit. Each links to one of 449 official source documents.
Last retrieved 2026-10-02. History back to 1976-12-19.
- Current rates
- 139,525
- Services
- 115
- Programs
- 33
- Lines with a plan rule
- 12of 22 service lines
By industry
Applied behavior analysis (ABA)Texas rates, labor costs and changesBehavioral healthTexas rates, labor costs and changesHome healthTexas rates, labor costs and changesHome care & personal careTexas rates, labor costs and changesPrivate duty nursingTexas rates, labor costs and changesSkilled nursing facilitiesTexas rates, labor costs and changesHospiceTexas rates, labor costs and changesIntellectual & developmental disabilitiesTexas rates, labor costs and changesOutpatient therapy (PT, OT, speech)Texas rates, labor costs and changes
Texas 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 | $27.56 | 15 min | $110.24 | 2 |
| ABA parent and caregiver training | ABA / autism services | $20.71 | 15 min | $82.82 | 6 |
| ABA therapy with plan changes by an analyst | ABA / autism services | $22.59 | 15 min | $90.36 | 4 |
| Group ABA therapy led by a technician | ABA / autism services | $1.63 | 15 min | $6.52 | 2 |
| Group ABA therapy led by an analyst | ABA / autism services | $2.53 | 15 min | $10.12 | 4 |
| One-on-one ABA therapy by a technician | ABA / autism services | $14.50 | 15 min | $58.00 | 2 |
| Behavioral health aide | Behavioral health | $6.15 | 15 min | $24.60 | 2 |
| Behavioral health services (fee schedule) | Behavioral health | $16.22 | — | $34.20 | 321 |
| Mental health assessment (non-physician) | Behavioral health | $28.91 | one time | — | 3 |
| Mental health counseling | Behavioral health | $59.53 | hour | $59.53 | 5 |
| Outpatient psychotherapy and diagnostic evaluation | Behavioral health | $83.40 | — | $113.88 | 664 |
| Skills training and development | Behavioral health | $25.02 | 15 min | $100.08 | 9 |
| Supervised living or host home (adults with mental illness) | Behavioral health | $131.79 | day | — | 2 |
| Therapeutic family home for youth (family-based alternative) | Behavioral health | $68.62 | day | — | 2 |
| FQHC / RHC visit (PPS or APM rate) | Clinics (FQHC/RHC) | $236.16 | encounter | — | 1253 |
| Dental services | Dental | $112.88 | — | — | 5357 |
| Durable medical equipment | Equipment & supplies | $182.97 | — | $52.32 | 2113 |
| Enteral and parenteral nutrition | Equipment & supplies | $21.61 | — | — | 135 |
| Medical supplies | Equipment & supplies | $9.36 | — | — | 1244 |
| Orthotics and prosthetics | Equipment & supplies | $248.54 | — | $96.72 | 4097 |
| Adult day health (medical model) | Other home & community services | $16.72 | unit (3-5 hours = 1 unit; 6+ hours = 2 units) | — | 5 |
| Adult day services | Other home & community services | $18.59 | 3-6 Hours = 1 unit | — | 7 |
| Adult foster care | Other home & community services | $33.10 | day | — | 7 |
| Assisted living / alternative living services | Other home & community services | $55.78 | day | — | 77 |
| Case management / support coordination | Other home & community services | $32.91 | month | $105.56 | 23 |
| Community transition (moving out of an institution) | Other home & community services | $158.28 | one time | — | 10 |
| Emergency response system installation | Other home & community services | $50.00 | one time | — | 6 |
| Emergency response system monitoring | Other home & community services | $37.61 | month | — | 12 |
| Family and peer mentoring | Other home & community services | $6.25 | 15 min | $25.00 | 3 |
| Financial management services (self-direction) | Other home & community services | $120.55 | month | $482.20 | 61 |
| Home-delivered meals | Other home & community services | $6.46 | meal | — | 8 |
| Interpreter services | Other home & community services | $31.48 | 15 min | $125.90 | 4 |
| Nursing assessment | Other home & community services | $95.33 | one time | — | 2 |
| Nursing respite (RN or LPN) | Other home & community services | $9.57 | 15 min | $38.28 | 12 |
| Prescribed pediatric extended care (medical day care) | Other home & community services | $40.09 | 4.25 hours or more | $40.09 | 15 |
| Requisition fee for adaptive aids or home modifications | Other home & community services | $140.81 | one time | $7.76 | 187 |
| Respite care (daily) | Other home & community services | $71.24 | day | — | 83 |
| Respite care (hourly) | Other home & community services | $22.29 | hour | $22.29 | 63 |
| Respite in a facility (daily) | Other home & community services | $6.01 | day | $5.87 | 142 |
| Self-direction coaching / supports broker | Other home & community services | $26.52 | hour | $26.52 | 14 |
| Service planning meeting | Other home & community services | $104.32 | one time | $18.47 | 7 |
| Home health aide visit | Home health | $46.09 | 15 min | $184.36 | 1 |
| Home health nurse visit (RN or LPN) | Home health | $98.92 | 15 min | $395.68 | 2 |
| Home health occupational therapy | Home health | $72.95 | hour | $72.95 | 6 |
| Home health physical therapy | Home health | $77.43 | hour | $77.43 | 6 |
| Home health speech therapy | Home health | $76.29 | hour | $76.29 | 3 |
| Home health visit (other or unspecified) | Home health | $99.53 | — | $95.36 | 18 |
| RN management of the home care plan | Home health | $11.05 | 15 min | $44.20 | 4 |
| Hospice continuous home care (hourly) | Hospice | $1,473.41 | day | — | 510 |
| Hospice end-of-life visit add-on (per hour) | Hospice | $61.39 | hour | $61.39 | 514 |
| Hospice general inpatient care (daily) | Hospice | $1,077.95 | day | — | 512 |
| Hospice inpatient respite (daily) | Hospice | $505.80 | day | — | 512 |
| Hospice physician direct care (per service) | Hospice | $55.05 | unit | — | 128 |
| Hospice room and board in a nursing home | Hospice | $196.85 | day | — | 15 |
| Hospice routine home care (daily) | Hospice | $187.49 | day | — | 1024 |
| Inpatient DRG pricing input (outlier, cost ratio, stay) | Hospital inpatient | $50.00 | percent of allowable charges | — | 526 |
| Inpatient DRG relative weight | Hospital inpatient | $2.03 | weight | — | 1332 |
| Inpatient hospital stay (DRG base rate) | Hospital inpatient | $5,145.04 | discharge | — | 637 |
| Inpatient hospital stay (per diem) | Hospital inpatient | $529.59 | day | — | 74 |
| Outpatient hospital (percent of charges or cost) | Hospital outpatient | $19.00 | percent of allowable charges | — | 415 |
| Outpatient hospital services (fee schedule) | Hospital outpatient | $172.75 | — | — | 1089 |
| Surgery center facility fee (per procedure) | Hospital outpatient | $1,063.52 | — | — | 3354 |
| Behavior support services (disability waiver) | IDD services | $79.53 | hour | $79.53 | 7 |
| Community integration / community access (IDD) | IDD services | $16.80 | hour | $16.80 | 34 |
| Consultative clinical assessment (IDD) | IDD services | $79.53 | hour | $79.53 | 1 |
| Day habilitation / day program (IDD) | IDD services | $10.98 | hour | $9.96 | 37 |
| Employment exploration | IDD services | $29.66 | hour | $29.66 | 17 |
| ICF/IID stay (daily rate) | IDD services | $196.62 | day | — | 18 |
| In-home and community living supports (IDD) | IDD services | $4.46 | hour | $17.84 | 32 |
| Intervener for a person who is deaf-blind | IDD services | $27.74 | hour | $27.74 | 8 |
| Prevocational services | IDD services | $10.48 | hour | $10.48 | 7 |
| Residential habilitation / group home supports | IDD services | $194.31 | day | — | 10 |
| Shared living / host home / family model | IDD services | $72.56 | day | — | 9 |
| Supported employment (job coaching) | IDD services | $26.07 | hour | $28.61 | 24 |
| Supported employment follow-along | IDD services | $6.58 | 15 min | $26.32 | 9 |
| Clinical lab tests | Lab & pathology | $18.28 | — | — | 26864 |
| Nurse aide training and competency testing (NF) | Nursing facility | $58.00 | ceiling | — | 9 |
| Nursing home stay (daily rate) | Nursing facility | $225.64 | day | — | 79 |
| Specialty nursing home daily rate (pediatric or IDD class) | Nursing facility | $302.02 | day | — | 5 |
| Brain/spinal cord injury rehab (state program, not Medicaid) | Other | $28.37 | 15 min | $74.36 | 68 |
| Dialysis facility composite rate (per treatment) | Other | $126.70 | — | — | 593 |
| Directed payment uniform increase (required MCO uplift) | Other | $78.62 | percent increase over MCO paid amount | — | 4 |
| Companion care | Personal care & attendant | $43.67 | 8-12 hour shift | — | 2 |
| Flexible family support (attendant or nurse) | Personal care & attendant | $8.54 | hour | $33.66 | 56 |
| Homemaker / housekeeping help | Personal care & attendant | $17.40 | hour | $17.40 | 1 |
| Personal care / attendant care (hourly) | Personal care & attendant | $4.46 | hour | $17.04 | 124 |
| Pharmacy dispensing fee | Pharmacy | $1.96 | prescription | — | 5 |
| Physician-administered drugs (J-codes) | Pharmacy | $12.08 | percent of AWP | — | 12983 |
| Private duty nursing (hourly shifts) | Private duty nursing | $29.69 | hour | $36.32 | 40 |
| Waiver nursing (RN or LPN, by the 15 minutes) | Private duty nursing | $34.14 | hour | $36.17 | 127 |
| Anesthesia base units (per procedure) | Physician & professional | $5.00 | base unit | — | 2288 |
| Physician and practitioner services (fee schedule) | Physician & professional | $121.62 | — | $111.28 | 49096 |
| Physician fee schedule conversion factor | Physician & professional | $28.07 | per anesthesia unit | — | 1065 |
| Imaging and radiology | Radiology | $66.47 | — | — | 15429 |
| Activity therapy | Therapy (PT/OT/speech) | $19.36 | hour | $77.44 | 13 |
| Audiology and auditory integration training | Therapy (PT/OT/speech) | $52.73 | hour | $52.73 | 8 |
| Cognitive rehabilitation therapy | Therapy (PT/OT/speech) | $19.88 | hour | $79.52 | 21 |
| Nutrition counseling (dietitian) | Therapy (PT/OT/speech) | $30.59 | hour | $101.56 | 39 |
| Occupational therapy | Therapy (PT/OT/speech) | $33.75 | hour | $118.80 | 189 |
| Occupational therapy evaluation | Therapy (PT/OT/speech) | $116.19 | — | — | 316 |
| Orientation and mobility training (vision loss) | Therapy (PT/OT/speech) | $78.78 | hour | $78.78 | 2 |
| Orthotic and prosthetic fitting and training | Therapy (PT/OT/speech) | $32.57 | 15 min | $130.26 | 246 |
| Physical therapy | Therapy (PT/OT/speech) | $33.75 | hour | $118.80 | 394 |
| Physical therapy evaluation | Therapy (PT/OT/speech) | $116.19 | — | — | 324 |
| Speech-language evaluation | Therapy (PT/OT/speech) | $119.30 | — | — | 212 |
| Speech-language therapy | Therapy (PT/OT/speech) | $86.22 | hour | $76.29 | 121 |
| Swallowing and feeding evaluation | Therapy (PT/OT/speech) | $205.12 | — | — | 57 |
| Swallowing and feeding therapy | Therapy (PT/OT/speech) | $121.58 | — | — | 114 |
| Air ambulance transport | Transportation | $3,482.33 | — | — | 4 |
| Ambulance mileage | Transportation | $8.46 | mile | — | 8 |
| Ground ambulance transport | Transportation | $25.02 | — | — | 27 |
| Non-emergency medical transportation (NEMT) | Transportation | $27.81 | — | — | 6 |
| Waiver transportation (to community activities) | Transportation | $22.40 | hour | $19.61 | 15 |
| Eyeglasses and contact lenses | Vision & hearing | $47.34 | — | — | 1541 |
| Hearing aids and hearing services | Vision & hearing | $192.00 | — | — | 160 |
Most-compared billing codes in Texas
Where Texas ranks among states for codes published widely. Rank 1 = highest rate.
| Code | Service | Texas | All-state median | Rank |
|---|---|---|---|---|
| 10004 | Physician and practitioner services (fee schedule) | $36.21 | $35.52 | 9 of 19 |
| 10005 | Physician and practitioner services (fee schedule) | $60.63 | $60.63 | 10 of 19 |
| 10006 | Physician and practitioner services (fee schedule) | $41.54 | $39.90 | 8 of 19 |
| 10007 | Physician and practitioner services (fee schedule) | $74.38 | $76.74 | 11 of 19 |
| 10008 | Physician and practitioner services (fee schedule) | $42.66 | $46.94 | 11 of 19 |
| 10009 | Physician and practitioner services (fee schedule) | $89.82 | $93.03 | 11 of 19 |
| 10010 | Physician and practitioner services (fee schedule) | $59.78 | $65.32 | 11 of 19 |
| 10021 | Physician and practitioner services (fee schedule) | $45.75 | $49.77 | 14 of 19 |
| 10030 | Physician and practitioner services (fee schedule) | $111.43 | $119.43 | 11 of 19 |
| 10035 | Physician and practitioner services (fee schedule) | $69.33 | $70.26 | 12 of 19 |
| 10036 | Physician and practitioner services (fee schedule) | $35.08 | $35.41 | 12 of 19 |
| 10060 | Physician and practitioner services (fee schedule) | $90.38 | $76.16 | 6 of 19 |
| 10061 | Physician and practitioner services (fee schedule) | $156.05 | $129.16 | 5 of 19 |
| 10080 | Physician and practitioner services (fee schedule) | $185.43 | $78.73 | 2 of 19 |
| 10081 | Physician and practitioner services (fee schedule) | $254.53 | $127.86 | 3 of 19 |
| 10120 | Physician and practitioner services (fee schedule) | $89.53 | $77.44 | 6 of 19 |
| 10121 | Physician and practitioner services (fee schedule) | $154.93 | $135.29 | 7 of 19 |
| 10140 | Physician and practitioner services (fee schedule) | $100.20 | $86.45 | 6 of 19 |
| 10160 | Physician and practitioner services (fee schedule) | $81.68 | $69.52 | 6 of 19 |
| 10180 | Physician and practitioner services (fee schedule) | $151.28 | $148.10 | 9 of 19 |
| 11000 | Physician and practitioner services (fee schedule) | $23.02 | $24.52 | 11 of 19 |
| 11001 | Physician and practitioner services (fee schedule) | $12.35 | $12.36 | 11 of 19 |
| 11004 | Physician and practitioner services (fee schedule) | $450.14 | $437.21 | 6 of 19 |
| 11005 | Physician and practitioner services (fee schedule) | $613.46 | $573.02 | 5 of 19 |
| 11006 | Physician and practitioner services (fee schedule) | $554.93 | $542.16 | 7 of 19 |
| 11008 | Physician and practitioner services (fee schedule) | $208.64 | $206.56 | 9 of 19 |
| 11010 | Physician and practitioner services (fee schedule) | $231.84 | $225.24 | 9 of 19 |
| 11011 | Physician and practitioner services (fee schedule) | $249.24 | $229.46 | 9 of 19 |
| 11012 | Physician and practitioner services (fee schedule) | $348.03 | $326.26 | 9 of 19 |
| 11042 | Physician and practitioner services (fee schedule) | $50.80 | $50.80 | 10 of 19 |
| 11043 | Physician and practitioner services (fee schedule) | $128.55 | $134.21 | 12 of 19 |
| 11044 | Physician and practitioner services (fee schedule) | $188.61 | $182.12 | 9 of 19 |
| 11055 | Physician and practitioner services (fee schedule) | $12.91 | $14.80 | 13 of 19 |
| 11056 | Physician and practitioner services (fee schedule) | $18.24 | $20.38 | 12 of 19 |
| 11057 | Physician and practitioner services (fee schedule) | $23.86 | $26.13 | 11 of 19 |
| 11102 | Physician and practitioner services (fee schedule) | $31.44 | $32.23 | 11 of 19 |
| 11103 | Physician and practitioner services (fee schedule) | $18.24 | $18.65 | 11 of 19 |
| 11104 | Physician and practitioner services (fee schedule) | $39.01 | $40.43 | 11 of 19 |
| 11105 | Physician and practitioner services (fee schedule) | $21.33 | $22.05 | 11 of 19 |
| 11106 | Physician and practitioner services (fee schedule) | $47.15 | $49.21 | 11 of 19 |
Managed care in Texas
19 plans on record, 4 state-directed payment records.
Who sets the rate, line by line →Recent rate changes and notices
Frequently asked questions
Where does Texas publish its Medicaid fee schedules?
Texas publishes rates across 449 official documents (fee schedules, rate notices and bulletins). Every rate on this page links to its source document.
How many Medicaid rates does Texas publish?
139,525 rates are current across 115 services and 33 programs, with 534,278 versions on record since 1976-12-19.
Do Texas Medicaid managed-care plans pay the fee schedule?
For 12 of 22 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 Texas rate cardYour codes, what Texas pays, what plans must pay, and every change in 2026.