Medicaid is the single largest payer of behavioral health services in the US including substance use disorder treatment (SUD) services. The prevalence of SUD is the highest amongst Medicaid enrollees compared to other insurance beneficiaries. States use a combination of fee-for-service (FFS) and managed care payment arrangements.
This visual by KFF illustrates the variation: Share of Medicaid Population Covered under Different Delivery Systems.
* Note that these fee-for-service rates are a starting point for negotiating the rate and not the precise amount providers get paid because some states have supplemental payment structures. *
More importantly, fee-for-service rates also vary in coverage nationally. To address this, the Center for Dissemination and Implementation at Stanford (C-DIAS) developed this online tool to evaluate the range and level of Medicaid fee-for-service rates for SUD treatment services across the 50 states. This Medicaid Financing tool for SUD services enable a visual comparison and measures variability in physician Medicaid reimbursement rates by CPT code and state for SUD treatment services. Note that these fee-for-service rates are a starting point for negotiating the rate and not the actual amount providers get reimbursed.
We have compiled rates across the 50 states (with exception of TN, Puerto Rico) for the following CPT codes:
| wdt_ID | wdt_created_by | wdt_created_at | wdt_last_edited_by | wdt_last_edited_at | Current Procedural Terminology (CPT) | Description |
|---|---|---|---|---|---|---|
| 1 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99202 | Office or other outpatient visit, new patient |
| 2 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99203 | Office or other outpatient visit, new patient |
| 3 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99204 | Office or other outpatient visit, new patient |
| 4 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99205 | Office or other outpatient visit, new patient |
| 5 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 90853 | Group psychotherapy (other than of a multiple-family group) |
| 6 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 90791 | Psych diagnostic evaluation (not time dependent) |
| 7 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 90832 | Psychotherapy, 30 minutes with patient and/or family member (minimum time = 15 min) |
| 8 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 90834 | Psychotherapy 45 (38-52) min; Psychotherapy, 45 minutes with patient and/or family member |
| 9 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 90837 | Psychotherapy, 60 minutes with patient and/or family member (53+) min |
| 10 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 90846 | Family psychotherapy without patient, 50 minutes |
| 11 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99212 | Follow-up Outpatient E/M (10 min ATT) Problem focused/straightforward; Office or other outpatient visit, established patient |
| 12 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99213 | Follow-up Outpatient E/M (15 min ATT) Expanded problem /low complexity; Office or other outpatient visit, established patient |
| 13 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99214 | Follow-up Outpatient E/M (30 min ATT) Detailed/moderate complexity; Office or other outpatient visit, established patient |
| 14 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99215 | Follow-up Outpatient E/M (40 min ATT) Comprehensive/High complexity; Office or other outpatient visit, established patient |
| 15 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 90833 | Add-on Psychotherapy 30 min (16-37); Psychotherapy, 30 minutes with patient and/or family when performed with an evaluation and management service |
| 16 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 90836 | Add-on Psychotherapy 45 min (38-52); Psychotherapy, 45 minutes with patient and/or family when performed with an evaluation and management service |
| 17 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 90838 | Add-on Psychotherapy 60 min (53+); Psychotherapy, 60 minutes with patient and/or family when performed with an evaluation and management service |
| 18 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99221 | Initial hospital care, per day |
| 19 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99222 | Initial hospital care, per day |
| 20 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99231 | Subsequent hospital care, per day |
| 21 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99232 | Subsequent hospital care, per day |
| 22 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99233 | Subsequent hospital care, per day |
| 23 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 96372 | Injection for buprenorphine or naltrexone; Therapeutic, prophylactic, or diagnostic injection, specify substance, or drug; subcutaneous or intramuscular |
| 24 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99406 | Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes |
| 25 | alex | 07/01/2024 10:24 AM | alex | 07/01/2024 10:24 AM | 99407 | Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes |
Note: This dashboard is updated annually. Please click on the Fee Schedules listed under each state data table from the Interactive Map for the most up-to-date rates.
To learn more about Medicaid financing, please visit the Resources page.