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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
A0429Bls-emergencyNon-Emergency Transportation

Average paid per claim across 51 reporting states. National median $153.63. North Dakota pays $342.00, 123% 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
IL β€” Illinois$769.27+401%1,252,70733911%
UT β€” Utah$715.87+366%279,0775616%
DC β€” District of Columbia$579.24+277%235,198327%
AZ β€” Arizona$569.61+271%670,1818227%
MN β€” Minnesota$425.75+177%424,7777824%
ND β€” North Dakota$342.00+123%69,2881527%
NM β€” New Mexico$263.52+72%250,6345631%
PA β€” Pennsylvania$249.93+63%859,33438516%
WV β€” West Virginia$216.74+41%366,85811324%
CA β€” California$215.29+40%2,738,45238717%
NV β€” Nevada$211.79+38%289,2622722%
OK β€” Oklahoma$210.03+37%213,7148120%
MO β€” Missouri$200.50+31%541,12413535%
VT β€” Vermont$192.88+26%76,7664024%
HI β€” Hawaii$184.76+20%57,359417%
ID β€” Idaho$182.61+19%75,1013215%
MA β€” Massachusetts$182.12+19%1,611,82924237%
CT β€” Connecticut$179.37+17%1,833,71612241%
ME β€” Maine$177.55+16%171,0099638%
NY β€” New York$166.82+9%3,963,65042329%
OR β€” Oregon$166.16+8%270,862689%
MS β€” Mississippi$162.35+6%329,6363921%
MT β€” Montana$161.51+5%94,9644144%
TX β€” Texas$159.88+4%927,38631227%
IN β€” Indiana$158.29+3%899,91519615%
SD β€” South Dakota$153.63βˆ’0%43,2253435%
MI β€” Michigan$152.82βˆ’1%952,46315328%
WI β€” Wisconsin$145.30βˆ’5%506,04115315%
LA β€” Louisiana$140.70βˆ’8%556,5054320%
GA β€” Georgia$139.00βˆ’10%113,887165%
AR β€” Arkansas$127.06βˆ’17%226,9486219%
CO β€” Colorado$123.41βˆ’20%792,53411631%
WA β€” Washington$116.15βˆ’24%927,63314614%
KS β€” Kansas$115.57βˆ’25%103,7545130%
NC β€” North Carolina$112.43βˆ’27%879,69014424%
NJ β€” New Jersey$112.21βˆ’27%1,606,99826436%
NE β€” Nebraska$111.16βˆ’28%110,672299%
TN β€” Tennessee$108.52βˆ’29%647,34810826%
NH β€” New Hampshire$100.25βˆ’35%53,4964540%
SC β€” South Carolina$92.00βˆ’40%533,3648519%
FL β€” Florida$90.98βˆ’41%1,095,71014317%
WY β€” Wyoming$89.25βˆ’42%19,1131319%
OH β€” Ohio$86.28βˆ’44%1,431,13947523%
AK β€” Alaska$81.29βˆ’47%104,9032237%
VA β€” Virginia$80.18βˆ’48%846,30522126%
RI β€” Rhode Island$78.10βˆ’49%162,5283535%
AL β€” Alabama$74.53βˆ’51%261,7629321%
IA β€” Iowa$70.93βˆ’54%177,9639423%
DE β€” Delaware$53.31βˆ’65%241,9196122%
KY β€” Kentucky$52.10βˆ’66%603,46516923%
MD β€” Maryland$3.33βˆ’98%177,5074421%

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.