North Dakota Medicaid Fee Schedule 2026: Rates, Updates & Provider Guide

Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against ND HHS and Medicaid.gov official guidelines | Last Updated: May 2026

North Dakota Medicaid updated its fee schedules for 2026 with rate increases across nursing facilities, therapy services, behavioral health, dental, and home care.

This guide breaks down every major rate change, confirmed reimbursement amounts, and what providers and patients need to know this year.

Quick Summary:

• Nursing facility rates increased 3.2% starting January 1, 2026
• The average nursing facility rate is now $437.90 per day
• Speech therapy under CPT 92507 pays $85 per visit (among the highest in the nation)
• New provider types added: Licensed Master Social Workers (LMSWs) and LPNs in school settings
• Fee schedules are updated every Sunday on the ND HHS website

What Is the North Dakota Medicaid Fee Schedule?

The North Dakota Medicaid fee schedule is the official list of maximum payment rates for medical services. It tells providers the most they can be paid for each service under Medicaid.

North Dakota Medicaid pays the lesser of the provider’s billed amount or the
maximum rate on the fee schedule. All providers must bill their usual and customary
charges — not the schedule rate itself.

Who Manages the Fee Schedule?

The North Dakota Department of Health and Human Services (ND HHS) manages all
Medicaid fee schedules. You can find every schedule at
hhs.nd.gov/healthcare/medicaid/provider/fee-schedules.

How Often Are Rates Updated?

Fee schedules are posted as CSV files and updated every Sunday. Rates can also
change mid-year. When that happens, ND Medicaid notifies providers by letter and
web update — so check the ND HHS site regularly.

What Programs Do the Schedules Cover?

The fee schedules cover services under traditional Medicaid and Medicaid Expansion.
For Medicaid Expansion, Blue Cross Blue Shield of North Dakota (BCBSND) manages
a separate provider fee schedule portal. You can also review the full
Medicaid Fee Schedule in 2026 overview to compare how North Dakota’s rates
compare nationally.

Major Rate Changes Effective January 1, 2026

Several important rate changes took effect at the start of 2026. These changes came
from a formal Public Notice issued by ND HHS for Medicaid State Plan changes.

Here is a summary of every confirmed change:

Nursing Facility Rate Increase (3.2%)

Nursing facilities received a 3.2% inflationary rate increase for all dates of
service on or after January 1, 2026. The average nursing facility rate is now $437.90 per day.

North Dakota also introduced a new resident classification system called
ND PDPM (North Dakota Patient Driven Payment Model). This system classifies
residents using a three-letter code based on:

1. Speech-Language Pathology (SLP) needs
2. Nursing needs
3. Non-Therapy Ancillary (NTA) needs

Each facility reassesses residents every three months. The classification then
determines the daily rate. This approach is designed to better reflect the actual
care needs of each resident.

Fiscal Impact: ND Medicaid expects nursing facility costs to increase by
approximately $20 million over 12 months due to these changes.

Psychiatric Residential Treatment Facility (PRTF) Rate Increase (2.0%)

All PRTF services received a 2.0% inflationary rate increase effective
January 1, 2026. In-state PRTFs also received an additional adjustment based on
cost reports submitted under the current rate methodology.

A new benefit was also added: therapeutic leave days. Starting January 1, 2026,
Medicaid now reimburses up to 15 therapeutic leave days per certification of need period for individuals in a PRTF.

Fiscal Impact: PRTF changes are expected to increase Medicaid expenditures
by approximately $2.3 million over 12 months.

Unlisted Professional Service Codes

Effective January 1, 2026, ND Medicaid reimburses unlisted professional service codes at 34% of billed charges. This provides a clear, consistent payment rule
for codes not specifically listed in the fee schedule.

PPS Hospital Value-Based Program Update

Under the In-State PPS Hospital Value-Based Program, the percentage of Medicaid
revenue returned to the state was updated from 4% to 5% beginning January 1, 2026.

Lodging Reimbursement

Lodging reimbursement rates were updated to the January 2026 GSA (General Services Administration) rate, effective January 1, 2026.

Medicaid Expansion (BCBSND Capitated Rate)

The capitated monthly rate for Medicaid Expansion is confirmed to have increased
for 2026 based on actuarial certification and BCBSND acceptance. The specific
dollar amount has not been publicly confirmed as of May 2026.

Per Senate Bill 2012 (2023), BCBSND rates paid to providers under the Medicaid
Expansion program may not exceed 145% of Medicare reimbursement for any fee
schedule effective on or after January 1, 2025. Certain behavioral health services
are exempt from this cap. Providers can access the updated 2026 BCBSND fee schedules
at feeschedule.bcbsnd.com.

New Provider Types Added January 1, 2026

ND Medicaid expanded which provider types can bill Medicaid starting in 2026.
Two new provider categories were officially added.

Licensed Master Social Workers (LMSWs)

LMSWs are now recognized as Other Licensed Practitioners under ND Medicaid.
This allows LMSWs to bill directly for eligible services. The estimated fiscal
impact is $700,000 over 12 months.

Licensed Practical Nurses (LPNs) in School Settings

LPNs may now provide Nursing Services in school settings for children with
complex medical needs. This estimated fiscal impact is $10,000 over 12 months.

Therapy Services Fee Schedule 2026 (ST, OT, PT)

North Dakota Medicaid updated its coverage and billing rules for Speech Therapy (ST),
Occupational Therapy (OT), and Physical Therapy (PT) effective February 1, 2026.
These changes affect both children and adults.

Key Policy Change: Per-Visit to Per-Unit Billing

ND Medicaid moved from a per-visit limit to a per-unit limit for adult ST/OT/PT
services. This change was first announced December 31, 2025 and clarified
January 28, 2026.

The shift to per-unit billing creates consistency with how other Medicaid services
are billed. Providers can still request service authorization if a patient needs
additional services beyond the standard unit limit.

Speech Therapy Rate (CPT Code 92507)

The $85 rate for CPT 92507 has been confirmed for 2026. The American
Speech-Language-Hearing Association (ASHA) noted that North Dakota Medicaid
reimbursement rates for speech therapy remain among the highest Medicaid rates in the country.

The January 28, 2026 policy update confirmed that the new coding rules under
CPT 92507 apply to both pediatric patients under age 21 and adult beneficiaries.

PT and OT Per-Unit Rates

Data Note: Specific per-unit rates for physical therapy and occupational
therapy under the new 2026 policy are available in the General Services Fee Schedule CSV on the ND HHS website. These rates were not independently published
in an accessible format at the time of this report. Providers should download the
latest CSV directly from
hhs.nd.gov/healthcare/medicaid/provider/fee-schedules.

Behavioral Health Services Fee Schedule 2026

The Behavioral Health Services Fee Schedule was last updated May 24, 2026,
per the live ND HHS data feed. Effective January 1, 2026, ND Medicaid also refined
its Behavioral Health Rehabilitative Services policies, adding enhanced guidelines
for level-of-care determination and annual service limits.

Confirmed 2026 Behavioral Health Rates

The following rates are confirmed from the official ND HHS Behavioral Health
Services Fee Schedule CSV (updated May 24, 2026):

Telehealth Note: Telehealth is allowed for most 1915(i) services listed
above. Audio-only services require Modifier -93.

Behavioral Health Policy Changes for 2026

Starting January 1, 2026, ND Medicaid added:

• Enhanced guidelines for determining appropriate levels of care for members
  in Behavioral Health Rehabilitative Services
• Annual service limits for certain behavioral health services to ensure
  medical necessity
• These policy changes are expected to have a minimal fiscal impact

Dental Fee Schedule 2026

The ND Medicaid Dental Services Fee Schedule was last updated May 24, 2026.
North Dakota Medicaid has separate rates for child and adult dental services.

Confirmed 2026 Dental Rates

Dental Coverage Notes

• Service authorization is required for more than 2 evaluations per calendar
  year. Codes D0120, D0145, D0150, and D0180 share this annual limit.
• Teledentistry is allowed for many dental evaluation codes. Providers must
  add code D9995 or D9996 when billing via teledentistry.

Home & Community-Based Services (HCBS) Fee Schedule 2026

The following HCBS billing rates are confirmed effective January 1, 2026,
from the official ND HHS HCBS Billing Codes & RD Rates document.

HCBS Standard Rates (Effective January 1, 2026)

Rural Differential (RD) Rates — Individual QSPs (Effective January 1, 2026)

Providers in rural areas receive higher rates based on distance traveled.
Three tiers apply:

Rural Differential (RD) Rates — Agency QSPs (Effective January 1, 2026)

Complete Fee Schedule Index: All ND Medicaid Schedules (2026)

Here is a full overview of every ND Medicaid fee schedule with confirmed 2026
effective dates:

All schedules are available at
hhs.nd.gov/healthcare/medicaid/provider/fee-schedules.

Who Qualifies for North Dakota Medicaid in 2026?

North Dakota Medicaid covers several groups of residents. Eligibility is based on
income, household size, age, and other factors. You can check the full
Medicaid Eligibility in 2026 guide for detailed national rules.

Eligibility Categories

Income Limits Snapshot

North Dakota uses Modified Adjusted Gross Income (MAGI) for most Medicaid
eligibility decisions. Income is measured as a percentage of the Federal Poverty Level (FPL). For a full income chart by household size and state,
visit our Medicaid Income Limits by State in 2026 guide.

Source: Medicaid.gov / HHS 2026 Poverty Guidelines. Income limits may vary by program category.

What Does North Dakota Medicaid Cover?

North Dakota Medicaid covers a wide range of health services. Coverage may vary
by eligibility category and managed care plan.

Standard covered services include:

• Doctor visits and primary care
• Hospital stays (inpatient and outpatient)
• Emergency services
• Prescription drugs
• Mental health and substance use treatment
• Dental care (children and limited adult coverage)
• Vision care
• Speech, occupational, and physical therapy
• Home health services
• Nursing facility care
• Preventive screenings and immunizations
• CHIP coverage for children

For full coverage details, visit Medicaid.gov or
healthcare.gov/medicaid-chip.

How to Apply for North Dakota Medicaid in 2026

Applying for Medicaid in North Dakota is free. There is no enrollment deadline
for most categories — you can apply any time of year.

Step-by-step application process:

1. Gather your documents. You will need proof of identity, residency, income,
   and household size.
2. Choose your application method. You can apply online, by mail, by phone,
   or in person.
3. Apply online at the ND HHS self-service portal at
   hhs.nd.gov.
4. Apply by phone by calling 1-800-755-2604.
5. Submit your application. Make sure all information is complete to avoid delays.
6. Wait for your eligibility determination. Most applications are processed
   within 45 days (or 90 days if disability is a factor).
7. Receive your Medicaid card. If approved, you will get a Medicaid card in
   the mail. Your coverage start date will be listed on your approval notice.

Tip: Use our Medicaid Eligibility Calculator in 2026 before you apply
to estimate whether you qualify based on your income and household size.

What Happens After You Apply?

After submitting your application, ND HHS will review your information.
Here is what to expect during the process.

Eligibility Determination Timeline

After Approval

Once approved, you will receive a Medicaid card and details about your plan.
If your coverage is managed through BCBSND (Medicaid Expansion), you will also
receive plan-specific information.

Renewals

Medicaid eligibility must be renewed annually. ND HHS will send you a renewal
notice before your coverage ends. Respond quickly to avoid a gap in coverage.

Federal Context: How OBBBA Affects ND Medicaid in 2026

The One Big Beautiful Bill Act (OBBBA), signed on July 4, 2025, cut nearly
$1 trillion from Medicaid programs across the country over 10 years. This federal
action is creating pressure on state Medicaid budgets nationwide.

North Dakota’s shift from per-visit to per-unit billing for therapy services
(ST/OT/PT) is partly tied to managing cost pressures from this federal change.
Other states — including Colorado, Idaho, and North Carolina — have already cut
provider reimbursement rates since OBBBA’s passage. As of May 2026, North Dakota
has not announced broad provider rate cuts.

Confirmed Data Gaps: What Is Not Yet Publicly Available

Some 2026 ND Medicaid rate data is not yet independently verifiable. Here is
what providers should look up directly:

For all live rates, visit:
hhs.nd.gov/healthcare/medicaid/provider/fee-schedules

Frequently Asked Questions (FAQ)

Sources & Disclaimer

Last Updated: May 2026

Official Sources:

• ND HHS Medicaid Fee Schedules
• ND HHS Public Notice: Jan. 1, 2026 Medicaid State Plan Changes
• ND HHS Long-Term Care Services (NF Rates)
• ND Medicaid HCBS Billing Codes & RD Rates
• Medicaid.gov
• Healthcare.gov – Medicaid & CHIP
• BCBSND Medicaid Expansion Fee Schedule Portal

Provider Contact:

• Email: dhsmedicalservices@nd.gov
• Phone: 1-800-755-2604

Disclaimer: CheckMedicaid.com is not affiliated with any government agency.
This content is for educational purposes only. For official eligibility
determinations, contact the North Dakota Department of Health and Human Services
or visit Medicaid.gov.