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Fee Schedules

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Rates

Current Medicaid Fee Schedules

Medicaid Basic Fee Schedule

Includes but is not limited to: Physicians, lab and x-rays, chiropractic, dental (child & adult), ambulance services, audiology, speech, physical, and occupational therapies, podiatry, and vision services). The Durable Medical Equipment (DME) fee schedule is published separately from the Medicaid Basic Fee Schedule.

  • The publication of a fee or code does not guarantee North Dakota Medicaid covers a service. All coverage limits and prior authorizations apply.
  • For most services, North Dakota Medicaid reimburses providers the lesser of the billed amount or the maximum allowable fee established by North Dakota Medicaid.
  • The fee schedule lists for each:
    • Procedure code - the numerical identifier (generally CPT or HCPCS) for medical services or supplies.
    • Reimbursement allowable amounts for the procedure code.
  • Allowed amounts were current as of the date indicated on the fee schedule. Reimbursement rates may change during the year without an update occurring to the internet fee schedule information. North Dakota Medicaid notifies impacted providers of rate/fee changes through letter/web updates.
  • The use of required modifiers may result in a different fee from what is published as some modifiers affect pricing (e.g. professional component modifier, bilateral procedure modifier, etc.) Also, only the fees for the Basic Medicaid Fee Schedule are listed (physicians, etc.). Not all fees for different provider types are listed as in some instances allowable amounts will vary for the same code, depending on the type of provider.
  • The exclusion of a procedure code does not necessarily mean it is not a covered service. Codes with a zero price are not listed but could be for a manually priced service, or reimbursement may be based on an invoice.
  • North Dakota Medicaid requires all providers to bill their usual and customary charges for services provided to Medicaid recipients. Therefore, providers should not use the fee schedule to set their rates. "Usual and customary charge" means the provider's charge for providing the same service to persons not eligible for Medicaid benefits.
  • Any code listed may have a service limitation associated with it or need prior authorization from Medicaid or its designee.

Previous Fee Schedules

Medium