Rates and Fee Schedules

North Dakota Medicaid rates and fee schedules are organized below by provider type. Rate and fee schedules serve as an informational resource for providers and do not guarantee payment at the specific rate or fee listed. North Dakota Medicaid requires all providers to bill their usual and customary charges for services provided to Medicaid members. Providers should not use North Dakota Medicaid reimbursement to set rates. "Usual and customary charge" means the provider's charge for providing the same service to the general public.

• Each fee schedule lists:
  • Procedure code the numerical identifier (generally CPT or HCPCS) for medical services or supplies.
    • The publication of a fee or code does not guarantee North Dakota Medicaid coverage. Providers and members should review North Dakota Medicaid policy and guidance for more information about coverage criteria.  
    • The exclusion of a procedure code does not necessarily mean the procedure code is not a covered service. Codes without a set price are not listed on North Dakota Medicaid fee schedules, but may be manually priced, reimbursed based on invoice, or be reimbursed at zero.
  • Reimbursement allowable amounts for the procedure code.
    • For most services, North Dakota Medicaid reimburses the lesser of: 
      • the billed amount; or 
      • the maximum allowable fee established by North Dakota Medicaid.
    • North Dakota Medicaid requires all providers to bill their usual and customary charges for services provided to Medicaid members. Providers should not use the fee schedule to set rates. "Usual and customary charge" means the provider's charge for providing the same service to the general public.
• All coverage limits and prior authorizations apply.
  • Any code listed may have a service limitation or need prior authorization from North Dakota Medicaid or its designee. 
• Allowed amounts are current as of the date indicated on the fee schedule. Reimbursement rates may change during the year without an update occurring to the internet fee schedule information. North Dakota Medicaid notifies impacted providers of rate/fee changes through letter/web updates.
• The use of required modifiers may result in a different fee from the published fee as some modifiers affect pricing (e.g. professional component modifier, bilateral procedure modifier, etc.). 
• Fees are listed for Professional Services (physicians, etc.). Not all fees for different provider types are listed; allowable amounts may vary for the same code, depending on the type of provider.

Previous Fee Schedules