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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
T2016Habil res waiver per diemHome & Community-Based Services

Average paid per claim across 43 reporting states. National median $444.63. Kansas pays $400.38, 10% 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 9% of Nebraska’s. A lower figure here may reflect what this dataset cannot see rather than what the state spends.
StateAvg paid / claimvs medianClaimsProvidersCoverage
MA β€” Massachusetts$10,071.81+2165%890,8072537%
AL β€” Alabama$3,837.56+763%477,625121%
IA β€” Iowa$2,087.89+370%1,585123%
RI β€” Rhode Island$1,833.70+312%13,558535%
ME β€” Maine$1,671.26+276%1,382,4967538%
SD β€” South Dakota$1,656.46+273%400,0382135%
NH β€” New Hampshire$1,554.64+250%38,025340%
HI β€” Hawaii$1,173.92+164%66,193917%
PA β€” Pennsylvania$1,115.92+151%15,820416%
VA β€” Virginia$958.70+116%9,016526%
UT β€” Utah$707.70+59%427916%
IN β€” Indiana$626.92+41%1,523,5117415%
DE β€” Delaware$613.28+38%333,5201022%
CA β€” California$579.01+30%5,542217%
MD β€” Maryland$578.23+30%491,2221121%
DC β€” District of Columbia$572.10+29%977,1081727%
WY β€” Wyoming$518.12+17%386,0001919%
NJ β€” New Jersey$513.66+16%7,112236%
MT β€” Montana$457.93+3%70,1771044%
WI β€” Wisconsin$457.56+3%250,447515%
MO β€” Missouri$450.51+1%11,562,16319335%
NE β€” Nebraska$444.63βˆ’0%19,86319%
TN β€” Tennessee$428.51βˆ’4%1,244,6844426%
NY β€” New York$426.77βˆ’4%14,150129%
KS β€” Kansas$400.38βˆ’10%4,170,97512130%
ND β€” North Dakota$397.88βˆ’11%1,025,4032927%
ID β€” Idaho$384.45βˆ’14%274,505115%
OH β€” Ohio$383.93βˆ’14%36,640123%
AK β€” Alaska$358.36βˆ’19%1,124,2643137%
NM β€” New Mexico$358.04βˆ’19%2,468,1864031%
NV β€” Nevada$342.05βˆ’23%297,796422%
MI β€” Michigan$312.48βˆ’30%12,686128%
AZ β€” Arizona$311.75βˆ’30%4,542,6362827%
CO β€” Colorado$291.71βˆ’34%8,183,91619331%
IL β€” Illinois$278.69βˆ’37%186,227311%
FL β€” Florida$264.81βˆ’40%484,000717%
SC β€” South Carolina$247.36βˆ’44%3,239,6085219%
MN β€” Minnesota$242.87βˆ’45%3,352,6463424%
TX β€” Texas$195.46βˆ’56%4,501,32810927%
KY β€” Kentucky$193.91βˆ’56%8,542,40414623%
NC β€” North Carolina$186.62βˆ’58%816,5919324%
LA β€” Louisiana$34.46βˆ’92%1,846,9827520%
VT β€” Vermont$0.00βˆ’100%247,0991224%

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.