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Medicaid Integrity Analytics

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πŸ“–Methodology
βš–οΈCompare States
by Concourse

Data: CMS T-MSIS 2018-2024

Source: opendata.hhs.gov

Updated: Oct 20, 2026

Rate Benchmarks

What each state pays for the same procedure. Start from a code β€” no need to pick a state first.

High-spend codes billed in 20+ states

Restricted to widely-billed codes: a procedure billed in four states cannot tell you whether your rate is unusual.

T1019Personal care ser per 15 minT1015Clinic serviceT2016Habil res waiver per diem99213Office o/p est low 20 minS5125Attendant care service /15m99214Office o/p est mod 30 min99284Emergency dept visit mod mdmH2016Comp comm supp svc, per diem99283Emergency dept visit low mdmH2015Comp comm supp svc, 15 min99285Emergency dept visit hi mdm90837Psytx w pt 60 minutesS5102Adult day care per diem90834Psytx w pt 45 minutesT2021Day habil waiver per 15 minH2017Psysoc rehab svc, per 15 minT1017Targeted case managementT1020Personal care ser per diem90999Unlisted dialysis procedureA0427Als1-emergencyH2019Ther behav svc, per 15 min92507Tx sp lang voice comm indivT2033Res, nos waiver per diemT1000Private duty/independent nsgH2014Skills train and dev, 15 minH0020Alcohol and/or drug services; methadone administration and/or serviceH0004Behavioral health counseling and therapy, per 15 minutes97530Therapeutic activitiesA0429Bls-emergencyH0019Behavioral health; long-term residential (non-medical, non-acute care in aS9124Nursing care, in the home; b97153Adaptive behavior tx by tech97110Therapeutic exercisesT2023Targeted case mgmt per monthT1016Case managementS5130Homaker service nos per 15mH2036A/d tx program, per diemG0463Hospital outpt clinic visitH0036Comm psy face-face per 15minT2031Assist living waiver/diem
97530Therapeutic activitiesTherapy Services

Average paid per claim across 51 reporting states. National median $45.03. Georgia pays $64.44, 43% above the median.

State-by-state detail is in the table below.

Ranked by rate
Coverage differs across these states. Claims represent 44% of Montana’s Medicaid spending but only 5% of Georgia’s. A lower figure here may reflect what this dataset cannot see rather than what the state spends.
StateAvg paid / claimvs medianClaimsProvidersCoverage
AK β€” Alaska$140.36+212%548,24511837%
WV β€” West Virginia$94.11+109%698,76014124%
VT β€” Vermont$88.89+97%55,5723724%
OK β€” Oklahoma$81.14+80%1,557,61919620%
DC β€” District of Columbia$72.68+61%290,4054227%
TX β€” Texas$72.15+60%7,473,7371,62327%
NC β€” North Carolina$69.14+54%5,434,01552424%
NM β€” New Mexico$68.41+52%1,075,52321631%
ID β€” Idaho$67.55+50%1,625,60928215%
SC β€” South Carolina$66.37+47%2,863,14434719%
GA β€” Georgia$64.44+43%477,188875%
OR β€” Oregon$63.07+40%1,138,4662849%
ND β€” North Dakota$61.11+36%424,3506727%
MN β€” Minnesota$60.80+35%1,747,47526524%
AR β€” Arkansas$59.02+31%7,016,56158219%
VA β€” Virginia$58.31+29%2,802,51640326%
AZ β€” Arizona$57.62+28%4,033,54451227%
NY β€” New York$56.33+25%11,795,5122,06729%
MT β€” Montana$55.71+24%729,21119744%
NV β€” Nevada$54.89+22%2,099,95530822%
WY β€” Wyoming$52.65+17%134,3463919%
CO β€” Colorado$51.36+14%2,982,34968431%
KY β€” Kentucky$50.85+13%2,521,62354523%
MD β€” Maryland$49.34+10%2,143,36948421%
IL β€” Illinois$46.04+2%815,51335011%
WA β€” Washington$45.03βˆ’0%3,209,06259014%
HI β€” Hawaii$44.36βˆ’1%77,6605217%
LA β€” Louisiana$43.57βˆ’3%1,786,15933020%
FL β€” Florida$43.04βˆ’4%17,031,4732,32517%
PA β€” Pennsylvania$42.71βˆ’5%4,023,19671416%
IN β€” Indiana$41.56βˆ’8%3,716,69941215%
NE β€” Nebraska$40.85βˆ’9%571,8501329%
NJ β€” New Jersey$40.64βˆ’10%2,268,08252336%
MI β€” Michigan$40.64βˆ’10%2,692,77238928%
UT β€” Utah$38.60βˆ’14%174,70213316%
AL β€” Alabama$37.86βˆ’16%1,540,95332121%
TN β€” Tennessee$36.34βˆ’19%3,331,70934126%
WI β€” Wisconsin$35.36βˆ’21%999,56126715%
RI β€” Rhode Island$35.29βˆ’22%425,15426735%
ME β€” Maine$34.88βˆ’23%868,02220138%
MO β€” Missouri$34.30βˆ’24%1,361,44947635%
SD β€” South Dakota$34.02βˆ’24%121,2145435%
IA β€” Iowa$32.32βˆ’28%493,25213323%
MA β€” Massachusetts$29.33βˆ’35%1,559,28649337%
OH β€” Ohio$29.20βˆ’35%4,580,2081,06423%
KS β€” Kansas$26.46βˆ’41%913,53431130%
CA β€” California$25.74βˆ’43%5,402,7831,19217%
CT β€” Connecticut$25.18βˆ’44%2,504,71422841%
MS β€” Mississippi$22.78βˆ’49%3,167,99034521%
NH β€” New Hampshire$20.65βˆ’54%1,072,11220440%
DE β€” Delaware$19.61βˆ’56%729,6008022%

Average paid per claim is a ratio internal to the claims data, so unlike per-enrollee measures it needs no external denominator. It remains subject to one caveat: this extract carries no claim-type field, so fee-for-service claims and managed-care encounter records are mixed together, and states derive encounter amounts inconsistently. The coverage column indicates how much of each state’s program these claims represent.