What Your State Medicaid Pays an NP, and How to Look It Up

Does Medicaid pay an NP the full rate or a percentage?

It depends on the state, and the reason is that no federal rule sets the number. Federal Medicaid regulation defines nurse practitioner services and then hands the payment question to a different section rather than fixing a rate 1Ref 1Centers for Medicare & Medicaid Services, HHS (2026).§ 440.166 Nurse practitioner services..The federal Medicaid definition of nurse practitioner services, and the fact that paragraph (d) routes the payment question to another section instead of setting a rate.. Some states pay an NP the same amount they pay a physician for the same code. Others pay a stated percentage of it. Both are legal, and neither is unusual.

The section it points to settles the route rather than the amount. A state plan must provide that an NP's services may be reimbursed whether or not the NP is supervised by or associated with a physician, either through an independent provider agreement between the state and the NP or through the employing provider 2Ref 2Centers for Medicare & Medicaid Services, HHS (2026).§ 441.22 Nurse practitioner services..The requirement that a State plan allow an NP's services to be reimbursed regardless of physician supervision, either through an independent provider agreement with the state or through the employing provider: the route to payment, not the amount.. That is the enrollment question answered. It leaves the size of the check entirely open.

The percentage lives one level down, in the state plan and in the fee schedule your state Medicaid agency publishes.

Payment authority and practice authority are also separate questions, and they move independently. A state that pays an NP the full physician rate for a code may still require a collaborative agreement or protocol under its nurse practice act, and a state with no such requirement may still discount the rate.

Why there is no federal percentage to look up

Because the only federal standard on Medicaid rates is written in adjectives rather than numbers. Payments must be consistent with efficiency, economy and quality of care, and sufficient to enlist enough providers that services under the plan are available to beneficiaries at least to the extent they are available to the general population 3Ref 3Centers for Medicare & Medicaid Services, HHS (2026).§ 447.204 Medicaid provider participation and public process to inform access to care..The only federal standard a state Medicaid rate must meet (efficiency, economy, quality of care, and sufficient to enlist enough providers), and the requirement to consider provider and stakeholder input before submitting a state plan amendment that reduces or restructures rates.. There is no floor expressed as a percentage of anything, and no ceiling either.

The 85 percent figure most NPs have in mind is real, and it belongs to Medicare. For services other than assistant-at-surgery services, furnished beginning January 1, 1998, allowed amounts for the services of a nurse practitioner may not exceed 85 percent of the physician fee schedule amount for the service 4Ref 4Office of the Federal Register (2026).42 CFR 414.56 — Payment for nurse practitioners' and clinical nurse specialists' services.The Medicare 85 percent limit on allowed amounts for an NP's services for services furnished beginning January 1, 1998, and the historical 75 and 85 percent rural limits for 1992 through 1997, used here only to show the figure is a Medicare rule rather than a Medicaid default.. That is the Medicare 85% rule for NPs, sitting in the Medicare payment rules, and nothing in federal Medicaid law imports it into a state plan.

But state plans borrow the arithmetic anyway, which is how the two get confused. A state is free to write a percentage of its own physician fee into its plan, or to benchmark that physician fee to Medicare first and then take a percentage of the result. Both patterns are in use. Neither is a federal default, and a state that has done neither pays the full scheduled amount.

Even the Medicare number was not always single. Between January 1, 1992 and December 31, 1997, an NP's services furnished in a hospital in a rural area were limited to 75 percent of the physician fee schedule amount, and all other services in a rural area to 85 percent 4Ref 4Office of the Federal Register (2026).42 CFR 414.56 — Payment for nurse practitioners' and clinical nurse specialists' services.The Medicare 85 percent limit on allowed amounts for an NP's services for services furnished beginning January 1, 1998, and the historical 75 and 85 percent rural limits for 1992 through 1997, used here only to show the figure is a Medicare rule rather than a Medicaid default..

Two states, two different answers

New York pays a percentage of a percentage. New Mexico pays a flat 90 percent of its physician fee. Neither is the national rule and neither predicts the state you practice in, so read them for the two shapes a state answer takes: a benchmark chained to Medicare, or a straight discount off the state's own physician schedule.

Under the FY 2023-2024 Enacted Budget, New York was authorized to benchmark its Medicaid fee-for-service reimbursement rates to 80 percent of then-current Medicare rates for non-facility services, with fees for over 7,000 procedure codes increasing effective October 1, 2023. Nurse practitioners were then benchmarked to 95 percent of those newly established physician fees, across the Medicine, Drug, Surgery and Radiology fee schedules 5Ref 5New York State Department of Health, Office of Health Insurance Programs (2023).New York State Medicaid Update - August 2023 Volume 39 - Number 13.The New York worked example: Medicaid fee-for-service benchmarked to 80 percent of then-current Medicare non-facility rates, and nurse practitioners benchmarked to 95 percent of the newly established physician fees, effective October 1, 2023, across the Medicine, Drug, Surgery and Radiology schedules.. Read together, an NP's New York rate for a non-facility code was set at 95 percent of 80 percent of the Medicare amount.

That figure carries its date. The August 2023 Medicaid Update is a bulletin announcing benchmarks effective October 1, 2023, and bulletins get superseded: a later Medicaid Update or enacted budget can move either number. Confirm it against the current schedule before quoting it to anyone.

New Mexico states its rule in the disclaimer on the fee schedule page, above any rate table. Some providers may be limited to a percentage of the rate, the page says, and a certified nurse practitioner billing independently is limited to 90% of the fee of a physician practitioner 6Ref 6New Mexico Health Care Authority (Medical Assistance Division) (2026).Fee Schedules.The New Mexico worked example: a certified nurse practitioner billing independently is limited to 90% of the fee of a physician practitioner, plus the fee schedule disclaimer that it is a pricing guide, that reimbursement is the lesser of the usual and customary charge or the schedule amount, and that program policy prevails over the schedule.. The same disclaimer carries the caution that travels with any published schedule: it is a pricing guide rather than a coverage guide, reimbursement is limited to the lesser of the provider's usual and customary charge or the fee schedule amount, and where the schedule is in error the program's pricing policies prevail over it 6Ref 6New Mexico Health Care Authority (Medical Assistance Division) (2026).Fee Schedules.The New Mexico worked example: a certified nurse practitioner billing independently is limited to 90% of the fee of a physician practitioner, plus the fee schedule disclaimer that it is a pricing guide, that reimbursement is the lesser of the usual and customary charge or the schedule amount, and that program policy prevails over the schedule..

So the answer to your own question may not be in a rate table at all. It may be in the paragraph above one.

How to find your own state's number

Open your state Medicaid agency's provider pages and look for the fee schedule filed under nurse practitioner, not under physician. Many state programs publish a discipline-specific manual, and the percentage, where one exists, is often stated in the schedule's own front matter instead of buried in a policy document. Four steps get you from the agency's home page to your number.

1. Find the fee schedule page on your state Medicaid agency's site and locate the file named for nurse practitioners. New York's version shows the shape: the eMedNY Provider Manuals page for Nurse Practitioner carries a Fee Schedule, an Enhanced Program Fee Schedule, a Procedure Codes list and Nurse Practitioner Billing Guidelines as separate downloads 7Ref 7eMedNY (New York State Department of Health Medicaid fiscal agent) (2026).Provider Manuals - Nurse Practitioner.The shape of the state-level lookup: a discipline-specific Nurse Practitioner provider manual page carrying a Fee Schedule, an Enhanced Program Fee Schedule, a Procedure Codes list and Nurse Practitioner Billing Guidelines as separate downloads.. 2. Read the front matter and the disclaimer before you read the rate table. That is where a percentage limit is stated when there is one, as New Mexico's is 6Ref 6New Mexico Health Care Authority (Medical Assistance Division) (2026).Fee Schedules.The New Mexico worked example: a certified nurse practitioner billing independently is limited to 90% of the fee of a physician practitioner, plus the fee schedule disclaimer that it is a pricing guide, that reimbursement is the lesser of the usual and customary charge or the schedule amount, and that program policy prevails over the schedule.. 3. Compare the NP schedule against the physician schedule for the same code. A constant ratio between them is your answer. Identical amounts mean your state pays the full scheduled rate for that code. 4. Check the code list as well as the rate. Whether the schedule prices the longer psychotherapy hour the same way is a separate lookup in the same file, and it is where Medicaid's 90834 payment cap comes up.

One limit on all of it. A published schedule is the fee-for-service schedule, and what a Medicaid managed-care plan pays is contracted between the plan and the practice and goes unpublished, so state Medicaid vs its MCOs is a separate enrollment and a separate rate conversation. Ask each plan for its rate exhibit before signing.

Whatever the percentage is, it is the whole of the revenue

A state plan must limit participation in the Medicaid program to providers who accept, as payment in full, the amounts paid by the agency plus any deductible, coinsurance or copayment required by the plan 8Ref 8Centers for Medicare & Medicaid Services, HHS (2023).Acceptance of State payment as payment in full.The payment-in-full rule: a State plan must limit Medicaid participation to providers who accept the agency's payment plus any plan-required deductible, coinsurance or copayment as payment in full, so the state's percentage is the whole collection on the visit.. The percentage is therefore the entire collection on that visit, and the gap between it and your usual charge is not billable to the member.

That one rule is what makes the percentage worth calculating before you enroll rather than after. An NP weighing whether to take Medicaid at all is weighing a published number against the cost of delivering the visit, with no top-up behind it and no side arrangement available on a covered service.

The regulation does not tell you whether that rate clears your cost per visit. It tells you there is no second payment coming, which is what makes the arithmetic possible in advance, with your own cost figures and your own accountant.

Watch for the change before it lands

A state must provide public notice of any significant proposed change in its methods and standards for setting payment rates for services, before the change takes effect, and a website maintained by the single state agency is one of the permitted venues 9Ref 9Centers for Medicare & Medicaid Services, HHS (2026).§ 447.205 Public notice of changes in Statewide methods and standards for setting payment rates..The requirement of public notice before a significant change in statewide rate-setting methods and standards, the state agency website as a permitted venue, and the carve-out that no notice is required for a change conforming to Medicare methods or levels.. The page you use to look up the rate is often the same page that warns you it is moving. Put a recurring reminder on it.

But that notice requirement has a hole worth knowing about. No public notice is required when the change is being made to conform to Medicare methods or levels of reimbursement 9Ref 9Centers for Medicare & Medicaid Services, HHS (2026).§ 447.205 Public notice of changes in Statewide methods and standards for setting payment rates..The requirement of public notice before a significant change in statewide rate-setting methods and standards, the state agency website as a permitted venue, and the carve-out that no notice is required for a change conforming to Medicare methods or levels.. A rate benchmarked to a percentage of Medicare, the New York shape above, is what that carve-out covers, so a Medicare change can reach your schedule with no separate state announcement.

There is a door in the other direction too. Before submitting a state plan amendment that proposes to reduce or restructure Medicaid service payment rates, a state must consider input from beneficiaries, providers and other affected stakeholders on beneficiary access to the affected services and the impact the proposed rate change will have 3Ref 3Centers for Medicare & Medicaid Services, HHS (2026).§ 447.204 Medicaid provider participation and public process to inform access to care..The only federal standard a state Medicaid rate must meet (efficiency, economy, quality of care, and sufficient to enlist enough providers), and the requirement to consider provider and stakeholder input before submitting a state plan amendment that reduces or restructures rates.. That is the formal opening for a solo NP to be on the record about the rate, and it happens before the amendment goes to CMS rather than after.

Bookmark two pages: the nurse practitioner fee schedule, and wherever your agency posts its public notices.