Medicaid is the single largest payer of behavioral health services in the US including substance use disorder treatment (SUD) services. Research shows that the prevalence of SUD is the highest amongst Medicaid enrollees compared to other insurance beneficiaries. Moreover, Medicaid fee-for-service rates 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 enables a visual comparison and measures variability in physician Medicaid reimbursement rates by CPT code and state for SUD treatment services.

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 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 99202 Office or other outpatient visit, new patient
2 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 99203 Office or other outpatient visit, new patient
3 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 99204 Office or other outpatient visit, new patient
4 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 99205 Office or other outpatient visit, new patient
5 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 90853 Group psychotherapy (other than of a multiple-family group)
6 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 90791 Psych diagnostic evaluation (not time dependent)
7 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 90832 Psychotherapy, 30 minutes with patient and/or family member (minimum time = 15 min)
8 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 90834 Psychotherapy 45 (38-52) min; Psychotherapy, 45 minutes with patient and/or family member
9 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 90837 Psychotherapy, 60 minutes with patient and/or family member (53+) min
10 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 90846 Family psychotherapy without patient, 50 minutes
11 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 99212 Follow-up Outpatient E/M (10 min ATT) Problem focused/straightforward; Office or other outpatient visit, established patient
12 alex 01/07/2024 10:24 AM alex 01/07/2024 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 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 99214 Follow-up Outpatient E/M (30 min ATT) Detailed/moderate complexity; Office or other outpatient visit, established patient
14 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 99215 Follow-up Outpatient E/M (40 min ATT) Comprehensive/High complexity; Office or other outpatient visit, established patient
15 alex 01/07/2024 10:24 AM alex 01/07/2024 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 01/07/2024 10:24 AM alex 01/07/2024 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 01/07/2024 10:24 AM alex 01/07/2024 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 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 99221 Initial hospital care, per day
19 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 99222 Initial hospital care, per day
20 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 99231 Subsequent hospital care, per day
21 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 99232 Subsequent hospital care, per day
22 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 99233 Subsequent hospital care, per day
23 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 96372 Injection for buprenorphine or naltrexone; Therapeutic, prophylactic, or diagnostic injection, specify substance, or drug; subcutaneous or intramuscular
24 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
25 alex 01/07/2024 10:24 AM alex 01/07/2024 10:24 AM 99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes

To learn more about Medicaid financing, please visit the Resources page.