Medicaid Access Monitoring Review Plans: Payment Rate Resource Toolkit

The Payment Resource Toolkit is a resource to help states identify and access data on Medicaid, Medicare, and commercial payment rates. It includes information about (and links to) payment rates for two public payers, Medicare and Tricare; links to states’ Medicaid physician fee schedules on the web; and information about sources of private payment rate data that may be available to states for the purpose of Medicaid rate comparisons. This toolkit is a living document: the information it contains will be updated regularly, as new data sources are identified and links and other information may change. Appendix A of the toolkit includes links to 50 states’ online physician fee schedules, with a description of the content of each site and a list of procedure (HCPCS/CPT) codes that states can use to map each code to a service category (primary care, including dental; physician specialist services; behavioral health; prenatal and postnatal obstetric services; and home health). The appendix is also available in an Excel file that enables users to cut and paste the CPT codes into the Payment Rate Comparison Tool: Appendix A.