ND Medicaid Procedure Code Look-Up

• Anesthesia Base – Anesthesia base rate established by CMS.  

• Professional Rate – Rate applied with modifier -26 

• Technical Rate – Rate applied with modifier -TC  

• General Rate – Procedures paid on RVU, flat rate, or total component   

• Rental Rate – Rate applied with modifier RR for DME

• ASC Rate - Facility Rate for ASC.  The procedure is not reimbursed in an ASC setting if no rate exists.  

• Child Rate -  Rate applied to CDT© dental codes for members through age 20 

• Adult Rate -  Rate applied to CDT© dental codes for members 21 and over.   

*Only the current rate is displayed, please refer to the Rates and Fee Schedule page for previous rates. 

• NDC Required – Identifies if a procedure code requires submitting a National Drug Code on the claim.  

• Federally Qualified Health Center (FQHC) Generate Encounter – Identifies if the procedure code qualifies to be paid at an encounter rate.  

• Rural Health Clinic (RHC) Generate Encounter – Identifies if the procedure code qualifies to be paid at an encounter rate.  

• Ordering/Referring/Prescribing Provider NPI required – Identifies if a procedure code requires submitting an ORP NPI on the claim.