North Dakota Medicaid reimbursement rates are the amounts that the state of North Dakotas Medicaid plans use to decide how much to pay for covered health care services. There is not one rate for every service or every provider. Each service and each provider might have rates. The rates can vary depending on the type of service. Who is providing it.
This means that the payment for health care services is not the same in every case. Different services get amounts. Different providers also get amounts. The system is set up so that each situation is considered on its own. The goal is to make sure that payments are fair and proper. The rates are important because they affect how much health care professionals and facilities get paid.
The rate varies by the type of service, the type of provider, the coding system (CPT, HCPCS or CDT), the date, the applicable fee schedule, modifiers, coverage, approvals and the way the payment is structured.
The North Dakota Health and Human Services (HHS) classifies its Medicaid reimbursement rates and fee schedules by type of provider, service and lists the rates, as the state declares them as informational only: the listing of a rate does not guarantee that a claim will be paid at that amount. It is also possible to compare this state’s reimbursement rates against other states, per our guide to Medicaid reimbursement rates by state.
And for providers, billers or practice managers searching the rates, the most efficient approach is to be specific: start first with a code, and then research its effective date, coverage, rate and billing rules.
Did North Dakota Medicaid Rates Increase in 2026?
Yes. Effective July 1, 2026, the statewide Medicaid program increased rates by 2% across the board to remain aligned with the rising cost of services. This is the second year of the two-year budget cycle.
In addition, services that use the Relative Value Unit (RVU) method of determining reimbursement received a new conversion factor that reflects the 2026 Medicare RVUs and the changes in mix and utilization of services. For services rendered on or after July 1, 2026, the professional-services conversion factor is $37.5492. The ASC conversion factor is $32.41, and the anesthesia conversion factor is $27.06.
RVUs changed as well, so the fee for a certain procedure could go up, stay the same, or decrease, even though the overall effect on RVU-priced services reflects the 2% increase.
How to Find a North Dakota Medicaid Reimbursement Rate
The fastest way is to use the official North Dakota Medicaid Procedure Code Look-up Tool in tandem with the appropriate fee schedule.
Step-by-step lookup
- Determine the procedure code.
- Identify if the service uses a CPT, HCPCS or CDT code.
- Visit the North Dakota Medicaid Procedure Code Look-up Tool.
- Choose the category.
- You may select Professional, Dental, DME, Drugs or Labs.
- View the current rate.
- Based on the code, the tool displays either a professional, technical, general, rental, ASC, adult dental or child dental rate, as applicable.
- Review the rules and approvals.
- Look for information on telehealth, NDC, ORP NPI, service authorization, EVV and other policy notes.
- Verify the effective date and provider type.
A lookup from a search box might show a rate from a previous spreadsheet or fee schedule that is no longer in effect.
The tool is helpful for getting the rate for a single code, as it updates every Sunday morning and warns that a displayed rate in no way guarantees payment as a claim may be denied for many reasons.
North Dakota Medicaid Fee Schedule by Provider Type
Medicaid reimbursement rates for different services have different methods of payment.
Provider or Service| Rate Resource| Important Lookup Factor
Physicians and practitioners| Professional Fee Schedule| CPT + modifier + RVU
Dental| Dental Fee Schedule| CDT + age
DME| DME Fee Schedule| HCPCS + purchase/rental
Behavioral health| Behavioral Health Schedule| Code + authorization
Therapy| Professional/Therapy rates| CPT + time/modifier
Home health| Home Health Rates| Service + unit
HCBS/1915(i)| HCBS rates| Service + provider arrangement
Hospitals| Hospital payment rates| Facility + methodology
Nursing facilities| Nursing Facility Rates| ND PDPM classification
FQHCs| FQHC Rates| Encounter eligibility
RHCs| RHC Rates| Encounter eligibility
IHS/Tribal Health| Encounter Rates| Encounter requirements
NEMT| NEMT rates| Transportation/service type
Ambulance| Ambulance rates| Transport type and code
ASC| ASC Fee Schedule| Facility + procedure
A physician’s fee schedule cannot determine a hospital, nursing facility, FQHC or DME supplier’s rates, as each facility has different methodologies.
North Dakota Medicaid CPT, HCPCS and CDT Rates
Many people search for a North Dakota Medicaid CPT reimbursement rate, as CPT codes largely represent professional health care services. HCPCS codes, on the other hand, cover a wide range of services and supplies, while CDT codes represent dental services.
A single CPT code can have more than one component of payment. The Procedure Code Look-up Tool may display:
- Professional rate
- Technical rate
- General rate
- DME rental rate
- ASC facility rate
- Adult dental rate
- Child dental rate
- Anesthesia information
Modifiers can impact payment as well. A good example is CPT 92507 in the state’s 2026 updates, as for qualifying services rendered on or after February 1, 2026, modifier -52 can reduce payment to 50% of the current fee schedule amount, whereas modifier -22 may increase payment to 120%. So determining the code is only part of the task when figuring out the reimbursement rate.
North Dakota Medicaid Professional and Physician Rates
Physician services and reimbursement rates are based on the Relative Value Unit, or RVU, approach, where payment is calculated by multiplying the relative value of each component of service by a conversion factor, and adjusting for other factors.
For services rendered on or after July 1, 2026, North Dakota’s professional conversion factor is $37.5492.
Do not take this calculation to mean that a service described by a CPT code will be reimbursed at this rate, as variations in Medicare RVUs, modifiers, provider qualification, eligibility, coverage rules, NCCI edits and the place of service can impact the claim.
Dental, Behavioral Health, ABA and Therapy Rates
North Dakota Medicaid has specific resources for reimbursement rates for Dental, Behavioral Health and ABA services and Therapy.
Dental
Dental services use CDT codes. The tool displays different rates for adults and children and a dental claim can require a tooth number, quadrant and/or surface.
Behavioral Health and ABA
Behavioral Health services have their own rules, including individual limits and medical necessity and approval requirements. ABA providers should review the code and latest behavioral health or relevant policy.
Physical, Occupational and Speech Therapy
PT, OT and speech services rely heavily on procedure code, time rules and modifiers. An example of the nuance embedded in the 2026 changes for CPT 92507 shows how not every unit or service has the same reimbursement: the modifier and recorded service time can change the amount.
North Dakota Medicaid DME Rates
DME reimbursement rates are more involved than a simple HCPCS code look-up, as for each item there may be a purchase rate or a rental rate, a modifier and special coverage or approval requirements.
The Procedure Code Look-up Tool displays rental details for DME items, as well as any policy or approval requirements.
Review the DME fee schedule as well as the HCPCS code, modifier and policy before submitting a claim.
Nursing Facility Rates and ND PDPM
Nursing facility rates changed significantly in 2026, as the facilities received a 3.2% inflationary increase effective January 1, 2026, with the state transitioning to the ND Patient Driven Payment Model, or ND PDPM.
Under the new methodology, reimbursement rates are based on the individual characteristics and needs of each resident and are based on the Minimum Data Set (MDS) and its components of Speech-Language Pathology, Nursing and Non-Therapy Ancillaries. So a facility’s posted base rate is not necessarily the amount paid for each resident.
HCBS, 1915(i), Home Health and NEMT
North Dakota Medicaid lists the rates and additional information for Home and Community-Based Services, including 1915(i), developmental disability, autism, medically fragile and other programs, where reimbursement is based on the service and the provider arrangement, the served group and how the units are counted.
Home health rates are dependent upon the type of service. NEMT transportation reimbursement rates are based on the type of transportation and the procedure or service code. Approval and eligibility criteria can make a claim payable or non-payable.
FQHC, RHC and IHS/Tribal Encounter Rates
FQHCs, Rural Health Clinics and Indian Health Service or Tribal Health providers can be compensated for each encounter. The North Dakota procedure-code system indicates whether a procedure is considered an FQHC, RHC or IHS/Tribal encounter, which may impact reimbursement rates.
A procedure with a CPT payment code that would otherwise appear in the general professional fee schedule can have a different reimbursement rate as an encounter.
Fee Schedule vs. Actual Medicaid Payment
The fee on a schedule does not always equal the amount paid. North Dakota Healthcare and Human Services (HHS) states that its rates and fee schedules serve only an informational purpose and do not guarantee that a claim will be paid at the amount listed on the fee schedule. Furthermore, providers are required to bill their usual and customary charges.
The following can influence the amount paid:
- Provider enrollment and eligibility
- Member eligibility (linked to North Dakota Medicaid income limits and other factors)
- Covered vs. non-covered services
- CPT/HCPCS/CDT code
- Modifier
- Place of service
- Prior/service authorization
- NCCI edits
- Telehealth requirements
- Provider type
- Claim edits
- Managed-care or other applicable arrangements
- Manual/invoice pricing
Coverage and reimbursement are two different determinations: a service with a listed rate may require approval or additional documentation before being reimbursed.
How Often Are North Dakota Medicaid Rates Updated?
North Dakota publishes current fee schedules and archives previous rate schedules separately.
The Procedure Code Look-up Tool is updated weekly, and each fee schedule has its own effective date. When searching, make sure to review the currently effective schedule and double-check against the date of service: a rate found in a search engine, directory or a spreadsheet may not be applicable.
When determining the rates for 2026–2027, be sure to separate the January 2026 changes from the July 1, 2026 rate updates.
What About North Dakota Medicaid Reimbursement Rates for 2027?
Do not assume that there will be a uniform increase across the board in 2027 unless the state announces a change.
In the meantime, refer to the latest updated North Dakota HHS rate schedules, provider notices and policy changes. Past rates are useful for comparisons, but should never be used in the place of the current schedule when submitting a claim. To see how other states operate, visit this guide covering Medicaid reimbursement rates by state.
North Dakota Medicaid Rate Lookup: What to Check Before Billing
Go through this list before submitting a claim:
- Correct CPT, HCPCS or CDT code
- Current effective date
- Correct provider type
- Current fee schedule
- Applicable modifier
- Place of service
- Coverage status
- Prior/service authorization
- NCCI requirements
- Telehealth eligibility
- NDC or ORP NPI requirements where applicable
- EVV requirements where applicable
- Any policy-specific limitations
FAQs About North Dakota Medicaid Reimbursement Rates
What are North Dakota Medicaid reimbursement rates?
They are the amounts that the state’s Medicaid plans uses to determine reimbursement for services, which are determined by a number of factors that fall under the different categories of fee schedules and payment methodologies.
Where can I find the North Dakota Medicaid fee schedule?
On the official North Dakota Health and Human Services Rates and Fee Schedules page, which lists current and archiving rates by type of provider and service.
How do I look up a North Dakota Medicaid CPT code?
By using the North Dakota Medicaid Procedure Code Look-up Tool. Enter the CPT code and review its category, coverage, current rate, approval requirements, telehealth status and other claim-related details.
What is the 2026 North Dakota Medicaid conversion factor?
The conversion factor for professional services is $37.5492 for services on or after July 1, 2026. The ASC conversion factor is $32.41 and the anesthesia conversion factor is $27.06.
Does North Dakota Medicaid pay the full fee schedule amount?
Not necessarily, as the listed fee is only informational, and eligibility, coverage rules, modifiers, approvals, provider enrollment and claim edits can impact the payment amount.
Can modifiers change reimbursement?
Yes: the 2026 update to CPT 92507 contains several examples of how different modifiers can reduce or increase reimbursement for qualifying services.
Does North Dakota Medicaid cover every CPT code?
No, as the coverage is dependent on the procedure and the policy. The Procedure Code Look-up Tool will display coverage and requirements for each code.
What does North Dakota Medicaid pay for ABA services?
It is dependent on the procedure codes, provider rules and approvals, as well as the current behavioral health or ABA-related policies for the code in question.
What are North Dakota Medicaid nursing facility rates?
They differ by facility and groups of residents, as the state transitioned to the ND Patient Driven Payment Model on January 1, 2026.
Are North Dakota Medicaid rates the same for every provider?
No, as the type of service and the payment methodology (as well as the facility, procedure code and claim details) can impact the reimbursement rate.
Conclusion
The North Dakota Medicaid program has different fee schedules and ways of paying providers. The biggest changes in 2026 are a 2% raise that starts on July 1 2026 and a professional conversion factor of $37.5492. There are also changes to the surgical center conversion factor and the anesthesia conversion factor.
Another change is the move to the North Dakota Patient Driven Payment Model for nursing facilities. The North Dakota Medicaid program has different fee schedules and ways of paying providers. The biggest changes in 2026 are a 2% raise that starts on July 1 2026 and a professional conversion factor of $37.5492.
There are also changes to the surgical center conversion factor and the anesthesia conversion factor. Another change is the move to the North Dakota Patient Driven Payment Model, for nursing facilities.
Official Resources
- Check Current ND Medicaid Rates — North Dakota HHS
- See the Medicare RVUs Behind Your Fees — CMS Physician Fee Schedule
- Verify NCCI Billing Edits — Medicaid.gov
- Find the Right HCPCS Code — CMS
Disclaimer: I want to remind you that Medicaid rates, Medicaid coverage rules and Medicaid payment policies can change. The information above is for informational purposes only and should not be treated as a guarantee of claim payment, billing advice or a substitute, for current North Dakota Medicaid policies and official rate schedules.
About Naseer
Naseer has 10+ years of experience creating informative content and researching medicare topics. He focuses on simplifying Medicaid and benefits details to support readers find clear, reliable, and easy-to-understand guidance.