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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
S5125Attendant care service /15mHome & Community-Based Services

Average paid per claim across 45 reporting states. National median $104.61. Montana pays $91.19, 13% 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
WV β€” West Virginia$745.13+612%1,760,8244324%
FL β€” Florida$709.97+579%28,031617%
HI β€” Hawaii$639.03+511%78,3411717%
MS β€” Mississippi$336.24+221%1,676,2531821%
MA β€” Massachusetts$297.17+184%626,8924037%
SD β€” South Dakota$207.25+98%158,192435%
ND β€” North Dakota$178.55+71%269,6021827%
ME β€” Maine$160.76+54%929,490238%
SC β€” South Carolina$141.37+35%92,995719%
LA β€” Louisiana$140.40+34%25,317,71448720%
IN β€” Indiana$138.43+32%1,211,67412215%
DE β€” Delaware$135.01+29%738,0532322%
MN β€” Minnesota$132.55+27%1,055,1162724%
OR β€” Oregon$131.47+26%188,416199%
AZ β€” Arizona$123.35+18%28,112,10922427%
RI β€” Rhode Island$118.56+13%5,489,4188335%
AL β€” Alabama$114.40+9%14,708121%
TN β€” Tennessee$113.71+9%5,306,02315426%
ID β€” Idaho$111.87+7%936,0344515%
AK β€” Alaska$107.57+3%1,048,9072137%
KS β€” Kansas$105.96+1%11,007,70619730%
OH β€” Ohio$105.33+1%4,921223%
NM β€” New Mexico$104.61βˆ’0%1,829,6124531%
NC β€” North Carolina$102.68βˆ’2%11,556,35840024%
KY β€” Kentucky$100.02βˆ’4%135,546623%
NY β€” New York$96.84βˆ’7%3,573,4306129%
MT β€” Montana$91.19βˆ’13%33,244644%
MO β€” Missouri$90.41βˆ’14%468,658535%
GA β€” Georgia$86.62βˆ’17%5,515,06345%
PA β€” Pennsylvania$85.41βˆ’18%565,182416%
AR β€” Arkansas$80.39βˆ’23%1,625,3377519%
IA β€” Iowa$72.64βˆ’31%973,3938523%
UT β€” Utah$69.65βˆ’33%57,5901316%
MI β€” Michigan$64.53βˆ’38%4,067,945128%
CT β€” Connecticut$60.54βˆ’42%4,944141%
NE β€” Nebraska$59.45βˆ’43%2,38029%
TX β€” Texas$58.77βˆ’44%270,947,4111,68027%
NV β€” Nevada$57.62βˆ’45%41,888922%
WY β€” Wyoming$55.87βˆ’47%38,382819%
IL β€” Illinois$51.81βˆ’50%15,332211%
NJ β€” New Jersey$15.37βˆ’85%52,138636%
WI β€” Wisconsin$11.88βˆ’89%8,104,51329615%
CA β€” California$0.00βˆ’100%209,369417%
CO β€” Colorado$0.00βˆ’100%1,336,8163631%
WA β€” Washington$0.00βˆ’100%57114%

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.