Concourse Sentinel

Medicaid Integrity Analytics

πŸ‡ΊπŸ‡ΈNational OverviewπŸ”Provider SearchπŸ’ŠProcedures🚨Watchlistβ›”Exclusions (LEIE)

Insights

🎯Highest ConfidenceπŸ“‰Change Points⚑Impossible VolumeπŸ“ˆUpcoding DetectionπŸ₯Specialties

Cross-Dataset

πŸ•ΈοΈControl Clusters🏠Home Health🏒Entity Age

Investigations

πŸ—‚οΈCases

Federal Compliance

πŸ›οΈOverviewπŸ“ŠOIG QSRπŸ”„Monthly Screening⏸️§455.23 Suspensionsβ›”OIG Exclusion Refs🧾RAC Coordination🎯PERM Sample
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
H2017Psysoc rehab svc, per 15 minBehavioral Health

Average paid per claim across 43 reporting states. National median $72.72. Wisconsin pays $103.42, 42% 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
AZ β€” Arizona$401.96+453%656,79327027%
AK β€” Alaska$281.39+287%130,2041137%
CA β€” California$220.65+203%13,694,97148517%
IA β€” Iowa$160.03+120%96,0141623%
NM β€” New Mexico$141.62+95%243,7523231%
TX β€” Texas$132.68+82%1,731,5709227%
ME β€” Maine$122.76+69%435,2321538%
IN β€” Indiana$116.83+61%196,4541615%
MN β€” Minnesota$115.68+59%3,917,81222624%
KY β€” Kentucky$112.71+55%147,5281823%
ID β€” Idaho$112.40+55%767,20113715%
PA β€” Pennsylvania$111.54+53%3,230116%
VT β€” Vermont$105.72+45%1,097,3882824%
FL β€” Florida$103.62+42%12,512,3131,00617%
WI β€” Wisconsin$103.42+42%10,573,2935915%
NV β€” Nevada$94.18+30%166,51412922%
NY β€” New York$91.66+26%1,170,26212329%
DE β€” Delaware$83.32+15%613122%
NC β€” North Carolina$80.46+11%3,194,73714224%
ND β€” North Dakota$79.73+10%25,0671327%
WY β€” Wyoming$74.32+2%8,105919%
UT β€” Utah$72.72βˆ’0%922,6429416%
MS β€” Mississippi$70.49βˆ’3%1,206,7422621%
RI β€” Rhode Island$68.95βˆ’5%34,738135%
GA β€” Georgia$65.67βˆ’10%286,732215%
TN β€” Tennessee$65.02βˆ’11%686,0622326%
MD β€” Maryland$64.76βˆ’11%1,743121%
KS β€” Kansas$64.50βˆ’11%1,493,5586330%
VA β€” Virginia$63.59βˆ’13%2,825,0189726%
LA β€” Louisiana$59.88βˆ’18%6,352,69239720%
SC β€” South Carolina$59.44βˆ’18%1,275,5635119%
AL β€” Alabama$58.39βˆ’20%806,718221%
CO β€” Colorado$56.55βˆ’22%66,3593731%
IL β€” Illinois$51.77βˆ’29%696,1185811%
OK β€” Oklahoma$51.60βˆ’29%1,209,90224320%
OH β€” Ohio$50.38βˆ’31%2,405,54924023%
MA β€” Massachusetts$39.35βˆ’46%49137%
AR β€” Arkansas$38.74βˆ’47%1,748,52313119%
NE β€” Nebraska$33.82βˆ’53%70,20699%
MT β€” Montana$30.13βˆ’59%28,562344%
MO β€” Missouri$18.52βˆ’75%2,526,5192335%
NH β€” New Hampshire$17.30βˆ’76%3,085,8489940%
WA β€” Washington$7.32βˆ’90%19,5841214%

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.