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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 19, 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
H0004Behavioral health counseling and therapy, per 15 minutesBehavioral Health

Average paid per claim across 48 reporting states. National median $73.63.

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
CT β€” Connecticut$220.09+199%58,682641%
KY β€” Kentucky$216.11+193%1,535,30617523%
UT β€” Utah$167.02+127%1,046316%
PA β€” Pennsylvania$156.92+113%3,168,5571,41116%
ID β€” Idaho$141.65+92%1,803,40515815%
NV β€” Nevada$127.49+73%446,87532722%
IN β€” Indiana$124.64+69%1,113,0337615%
CA β€” California$121.35+65%7,491,59520517%
MN β€” Minnesota$117.90+60%15,849924%
NY β€” New York$107.71+46%1,631,27226629%
WY β€” Wyoming$98.96+34%11,5642819%
KS β€” Kansas$98.35+34%103,1857230%
IL β€” Illinois$89.64+22%8,641,87581011%
SD β€” South Dakota$88.31+20%12,6261835%
AR β€” Arkansas$87.15+18%389,04314319%
AZ β€” Arizona$86.40+17%13,749,1111,17527%
OR β€” Oregon$86.02+17%2,107,4972689%
NH β€” New Hampshire$82.93+13%163,3516840%
ND β€” North Dakota$82.64+12%79,0543727%
ME β€” Maine$80.39+9%2,907,74229138%
VT β€” Vermont$78.23+6%60,0941924%
WV β€” West Virginia$76.24+4%3,234,09416624%
NC β€” North Carolina$75.06+2%5,804624%
FL β€” Florida$74.71+1%145,4388817%
RI β€” Rhode Island$72.56βˆ’1%240,4307835%
CO β€” Colorado$69.97βˆ’5%1,175,65229531%
NJ β€” New Jersey$69.74βˆ’5%231,3406436%
MI β€” Michigan$65.53βˆ’11%817,92921028%
OK β€” Oklahoma$65.14βˆ’12%11,060,95563620%
GA β€” Georgia$63.66βˆ’14%62,836245%
DC β€” District of Columbia$63.38βˆ’14%528,1758327%
MD β€” Maryland$63.37βˆ’14%2,762,37938321%
AL β€” Alabama$59.66βˆ’19%620,7691621%
SC β€” South Carolina$57.06βˆ’23%53,2723719%
TX β€” Texas$56.65βˆ’23%194,2199227%
WA β€” Washington$55.60βˆ’24%2,837,64331814%
HI β€” Hawaii$55.27βˆ’25%144217%
OH β€” Ohio$53.60βˆ’27%486,22524823%
MA β€” Massachusetts$49.13βˆ’33%253,7072837%
WI β€” Wisconsin$46.56βˆ’37%54,127415%
MT β€” Montana$43.52βˆ’41%5,8332344%
VA β€” Virginia$42.20βˆ’43%1,123,24710426%
DE β€” Delaware$40.88βˆ’44%108,3531422%
TN β€” Tennessee$39.50βˆ’46%44,704726%
IA β€” Iowa$38.65βˆ’48%2,219123%
LA β€” Louisiana$37.88βˆ’49%62,3595520%
MO β€” Missouri$31.38βˆ’57%1,246,8394135%
AK β€” Alaska$0.00βˆ’100%372137%

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.