How the comparison is computed here Copy link
We divide a state’s fee-for-service Medicaid rate by the current Medicare office (non-facility) amount for the same code, before sequestration. Medicare adjusts by payment locality, so the Medicaid rate is compared with each Medicare locality in the state, and a state with several localities gives a range of ratios. The headline figure uses the state’s rest-of-state locality where it has one. Each state page summarizes the ratios for common codes with their median, and every code page shows the ratio with both sources.
What a state comparison leaves out Copy link
These are fee-for-service rates. Medicaid managed care plans negotiate their own rates, which can differ. Some states publish separate rates by provider type or modifier, so check which rate row a comparison uses. Medicaid fee schedules change on their own dates, which rarely line up with Medicare’s quarterly releases, so each comparison names both the Medicaid effective date and the Medicare release.
States covered Copy link
We hold fee-for-service schedules for four states: Texas, New York, Illinois and California. To ask for another state, use the dataset request form.
Frequently asked Copy link
Does Medicaid pay less than Medicare?
For physician services, most state Medicaid fee schedules pay below Medicare, but the gap varies by state and by code. Compare a specific code in a specific state.
How is Medicaid as a percent of Medicare calculated?
Divide the state’s Medicaid fee-for-service rate for a code by the Medicare office (non-facility) amount for the same code in that state, before sequestration. States with several Medicare localities give a range.
Do Medicaid managed care plans pay the fee-for-service rate?
Not necessarily. Managed care plans negotiate their own rates. The comparisons here use each state’s published fee-for-service schedule.
Sources Copy link
- TMHP Texas Medicaid fee schedules (static downloads)
- eMedNY Physician provider manual—fee schedule downloads
- Illinois HFS Practitioner Fee Schedule (downloads and Fee Schedule Key)
- DHCS Medi-Cal Provider Portal—Medi-Cal rates
- CMS Physician Fee Schedule overview (cms.gov)
Written from primary CMS sources—see how we source, compute, and verify everything on this site.
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