Medicaid Provider Information

Fee Schedules -North Dakota Medicaid

• 2011 ND Medicaid ASC Payment Groups, Rates and Codes
• Non-Emergency Transportation Fee Schedule 2011
• ND Medicaid BASIC Fee Schedule as of 07/01/2011
• ND Medicaid Dental - CHILD Fee Schedule as of 07/01/2011
• ND Medicaid Dental - ADULT Fee Schedule as of 07/01/2011
• ND Medicaid Professional Component Fee Schedule as of 07/01/2011
• ND Medicaid Technical Component Fee Schedule as of 07/01/2011
• ND Medicaid Ambulatory Behavioral Health Care Rates as of 07/01/2011
• ND Medicaid Health Management Program Fee Schedule as of 10/01/2011

 

Previous Fee Schedules - 2010

• ND DME Fee Schedules
• 2010 ND Medicaid ASC Payment Groups, Rates and Codes (510 kb pdf) Updated 8-25-2010
• ND Medicaid Non-Emergency Transportation Providers Fee Schedule as of 07/01/2010 (46 kb pdf)
• ND Medicaid BASIC Fee Schedule as of 07/01/2010 (1.41 MB pdf)
• ND Medicaid Dental - CHILD Fee Schedule as of 07/01/2010 (47kb pdf)
• ND Medicaid Dental - ADULT Fee Schedule as of 07/01/2010 (35kb pdf)
• ND Medicaid Professional Component Fee Schedule as of 07/01/2010 (203kb pdf)
• ND Medicaid Technical Component Fee Schedule as of 07/01/2010 (109kb pdf)
• ND Medicaid Ambulatory Behavioral Health Care Rates as of 07/01/2010 (11kb pdf)

Previous Fee Schedules - 2009

• ND Medicaid BASIC Fee Schedule as of 7-1-2009 (1.43 MB pdf) Updated March 2010
• ND Medicaid Dental CHILD Fee Schedule as of 7-1-2009 (51kb pdf)
• ND Medicaid Dental ADULT Fee Schedule as of 7-1-2009 (39kb pdf)
• ND Medicaid Professional Component Fee Schedule as of 7-1-2009 (224kb pdf)
• ND Medicaid Technical Component Fee Schedule as of 7-1-2009 (113kb pdf)
• Ambulatory Behavioral Health Care Rates as of 7-1-2010 (11kb pdf)

Previous Fee Schedules - 2008

• Medicaid BASIC Fee Schedule as of 7-1-2008 (1.47 MB pdf) Updated December 2009
• Medicaid Dental CHILD Fee Schedule as of 7-1-2008 (30 kb pdf)
• Medicaid Dental ADULT Fee Schedule as of 7-1-2008 (25 kb pdf)
• Medicaid Professional Component Fee Schedule as of 7-1-2008 (123 kb pdf)
• Medicaid Technical Component Fee Schedule as of 7-1-2008 ( 59 kb pdf)
  

Previous Fee Schedules - 2007

• Medicaid BASIC Fee Schedule as of 7-1-2007 (718 kb pdf)
• Medicaid Dental CHILD Fee Schedule as of 7-1-2007 (30 kb pdf)
• Medicaid Dental ADULT Fee Schedule as of 7-1-2007 (25 kb pdf)
• Medicaid Professional Component Fee Schedule as of 7-1-2007 (122 kb pdf)
• Medicaid Technical Component Fee Schedule as of 7-1-2007 ( 57 kb pdf)

Previous Fee Schedules - 2006

• 2006 ND Medicaid ASC Payment Groups, Rates and Codes (113 kb pdf) Updated 5-18-2007
• North Dakota Medicaid BASIC Fee Schedule as of 7-1-2006 (706 kb pdf)
• North Dakota Medicaid Dental CHILD Fee Schedule as of 7-1-2006 (30 kb pdf)
• North Dakota Medicaid Dental ADULT Fee Schedule as of 7-1-2006 (25 kb pdf)
• North Dakota Medicaid Professional Component Fee Schedule as of 7-1-2006 (117 kb pdf)
• North Dakota Medicaid Technical Component Fee Schedule as of 7-1-2006 (52 kb pdf)
  

 

Medicaid Basic Fee Schedule (includes but is not limited to: Physicians, lab and x-rays, chiropractic, dental (child & adult), ambulance services, audiology, speech, physical, and occupational therapies, podiatry, and vision services). The Durable Medical Equipment (DME) fee schedule is published separately from the Medicaid Basic Fee Schedule.

• The publication of a fee or code does not guarantee North Dakota Medicaid covers a service. All coverage limits and prior authorizations apply.
• For most services, North Dakota Medicaid reimburses providers the lesser of the billed amount or the maximum allowable fee established by North Dakota Medicaid.
• The fee schedule lists for each:
  • Procedure code - the numerical identifier (generally CPT or HCPCS) for medical services or supplies.
  • Reimbursement allowable amounts for the procedure code.
• Allowed amounts were 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 what is published as some modifiers affect pricing (e.g. professional component modifier, bilateral procedure modifier, etc.) Also, only the fees for the Basic Medicaid Fee Schedule are listed (physicians, etc.). Not all fees for different provider types are listed as in some instances allowable amounts will vary for the same code, depending on the type of provider.
• The exclusion of a procedure code does not necessarily mean it is not a covered service. Codes with a zero price are not listed but could be for a manually priced service, or reimbursement may be based on invoice.
• North Dakota Medicaid requires all providers to bill their usual and customary charge for services provided to Medicaid recipients. Therefore, providers should not use the fee schedule to set their rates. "Usual and customary charge" means the provider's charge for providing the same service to persons not eligible for Medicaid benefits.
• Any code listed may have a service limitation associated with it or need prior authorization from Medicaid or its designee.

 

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