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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
G0463Hospital outpt clinic visitHospital (Inpatient & Outpatient)

Average paid per claim across 51 reporting states. National median $33.94. Nevada pays $10.12, 70% below 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$210.31+520%161,5732637%
VA β€” Virginia$112.34+231%1,729,4277226%
DC β€” District of Columbia$97.49+187%226,4181127%
OH β€” Ohio$96.82+185%9,189,64815323%
NY β€” New York$92.92+174%1,950,71318229%
IA β€” Iowa$89.67+164%2,208,1127123%
CT β€” Connecticut$88.58+161%6,285,5663541%
MO β€” Missouri$83.03+145%2,519,6269835%
WA β€” Washington$81.31+140%4,810,93510314%
MN β€” Minnesota$79.10+133%4,494,0108224%
NM β€” New Mexico$78.01+130%1,581,5923831%
IN β€” Indiana$72.01+112%1,273,11010015%
ME β€” Maine$61.63+82%4,081,2155638%
ND β€” North Dakota$60.71+79%382,3121027%
OR β€” Oregon$60.28+78%1,117,518459%
IL β€” Illinois$52.76+55%225,6393011%
MI β€” Michigan$52.02+53%8,197,04515328%
OK β€” Oklahoma$49.04+44%48,2335020%
TN β€” Tennessee$47.37+40%1,484,3966426%
RI β€” Rhode Island$47.10+39%73,4465635%
UT β€” Utah$46.30+36%980,2802816%
AL β€” Alabama$42.81+26%868,9194321%
SC β€” South Carolina$41.67+23%248,2126519%
DE β€” Delaware$40.10+18%88,422822%
PA β€” Pennsylvania$36.54+8%454,83610116%
KY β€” Kentucky$33.94βˆ’0%2,510,2617723%
CA β€” California$33.54βˆ’1%3,012,47226817%
FL β€” Florida$32.58βˆ’4%1,236,48213417%
HI β€” Hawaii$29.71βˆ’12%128,5301317%
NC β€” North Carolina$27.24βˆ’20%2,137,0898624%
MA β€” Massachusetts$27.02βˆ’20%4,193,98310837%
MD β€” Maryland$24.11βˆ’29%380,6354721%
WY β€” Wyoming$22.17βˆ’35%4,461719%
AZ β€” Arizona$21.68βˆ’36%367,9334727%
NJ β€” New Jersey$19.68βˆ’42%760,0549136%
GA β€” Georgia$19.65βˆ’42%112,092215%
VT β€” Vermont$18.77βˆ’45%101,946824%
NE β€” Nebraska$18.69βˆ’45%445,855369%
CO β€” Colorado$16.44βˆ’52%76,1253331%
AR β€” Arkansas$15.73βˆ’54%402,3297419%
TX β€” Texas$15.30βˆ’55%586,60212227%
ID β€” Idaho$14.64βˆ’57%339,6372115%
SD β€” South Dakota$14.37βˆ’58%394,2834635%
WV β€” West Virginia$13.53βˆ’60%381,7553924%
KS β€” Kansas$12.73βˆ’62%271,5235230%
MS β€” Mississippi$11.94βˆ’65%503,3605421%
WI β€” Wisconsin$10.55βˆ’69%1,298,2269915%
NV β€” Nevada$10.12βˆ’70%67,2182322%
NH β€” New Hampshire$8.63βˆ’75%403,4073340%
LA β€” Louisiana$0.60βˆ’98%362,5226120%
MT β€” Montana$0.42βˆ’99%339,2422244%

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.