FEE SCHEDULES

The information contained in these schedules is made available to provide information and is not a guarantee by the State or the Department or its employees as to the present accuracy of the information contained herein. 

• Hospital Rates and Revenue Codes*
• Maximum Reimbursement Rates for Organ Transplant Procedures and Procurement
• Provider Type 10 Outpatient Surgery, Hospital Based - Provider Type 46 Ambulatory Surgical Center (ASC)
• Provider Type 12 Outpatient Hospital 
• Provider Type 14 Behavioral Health Outpatient Treatment
• Provider Type 15 Registered Dietitian  
• Provider Type 17
  • Specialty 166, Special Clinic, Family Planning
  • Specialty 169, Special Clinic, Obstetrical Care Clinic, Birthing Centers 
  • Specialty 171, Special Clinic Methadone
  • Specialty 174, Special Clinic, Public Health
  • Specialty 179, School Based Health Centers
  • Specialty 183, Comprehensive Outpatient Rehab Facilities
  • Specialty 195, Special Clinic, Community Health
  • Specialty 196, Special Clinic, Early Intervention
  • Specialty 198, Special Clinic, HIV
  • Specialty 215, Substance Abuse Agency Model (SAAM)                                                   
   
• Provider Type 20 Physician, MD., Osteopath
• Provider Type 21 Podiatrists
• Provider Type 22 Dentists 
  • Dental ID Waiver
   
• Provider Type 23 Hearing Aid Dispenser & Supplies
• Provider Type 24 Advanced Practice Registered Nurse
• Provider Type 25 Optometrist
• Provider Type 26 Psychologist
• Provider Type 27 Radiology
• Provider Type 29 Home Health Agency
• Provider Type 30 and 83 Personal Care Services  
• Provider Type 32
  • Provider Type 32 Ambulance, Spec 249 Comm Paramed 
  • Provider Type 32 Ambulance, Spec 932 Ambulance Air or Ground
   

• Provider Type 33 Durable Medical Equipment, Prosthetics, Orthotics & Supplies
• Provider Type 34 Therapy
• Provider Type 35, Specialty 987 Secure Non Emergency Behavioral Health Transport Reimbursement
• Provider Type 36 Chiropractor
• Provider Type 38 Waiver for Individuals with Intellectual Disabilities and Related Conditions (ID)
• Provider Type 39 Adult Day Health Center 
• Provider Type 41 Optician, Optical Business
• Provider Type 43 Laboratory, Pathology Clinical
• Provider Type 45 and 81 End Stage Renal Disease
• Provider Type 48 Waiver for the Frail Elderly (FE)
• Provider Type 55 Home Based Habilitation Services 
• Provider Type 57 Adult Residential Care Waiver 
• Provider Type 58 Waiver for Persons with Physical Disabilities (PD)
• Provider Type 59 Assisted Living Waiver
• Provider Type 60 School Health Services
• Provider Type 64 
  •  Provider Type 64 FFY 25 Reimbursement Rates - Compliant (10/2024) 
  •  Provider Type 64 FFY 24 Reimbursement Rates - Compliant Corrected
  •  Provider Type 64 FFY 24 Reimbursement Rates - Compliant 
  •  Provider Type 64 FFY 23 Reimbursement Rates - Non-Compliant
  • Provider Type 64 FFY 23 Reimbursement Rates - Compliant 
  • Provider Type 64 FFY 22 Reimbursement Rates - Non-Compliant
  • Provider Type 64 FFY 22 Reimbursement Rates - Compliant
  • Provider Type 64 FFY 21 Reimbursement Rates - Non-Compliant
  • Provider Type 64 FFY 21 Reimbursement Rates - Compliant
  • Provider Type 64 FFY 20 Reimbursement Rates - Non-Compliant
  • Provider Type 64 FFY 20 Reimbursement Rates - Compliant
   
• Provider Type 72 Nurse Anesthetist
• Provider Type 74 Nurse Midwife
• Provider Type 76 Audiologist
• Provider Type 77 Physician Assistant
• Provider Type 82 Rehabilitative Behavioral Health
• Provider Type 85 Applied Behavioral Analysis Fee Schedule
• Provider Type 86 Specialized Foster Care
• Provider Type 87 Crisis Services
•  Provider Type 89 Community Health Worker
•  Provider Type 90 Doula
•  Provider Type 91 Pharmacist 
•  Provider Type 93 Substance Use Treatment
•  Provider Type 95 Home and Community Based Waiver for Structured Family Caregiving