Every state, kept current
The Rates plan
$29/mo7-day free trialThe table on this page is a common-procedure sample. The full Maryland physician schedule has 64 codes.
- Every code on all 51 published schedules
- Full-schedule CSV export and state network lists
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Published codes
64
Physician procedures on the 2026 schedule
Median % of Medicare
108.5%
vs national Medicare, GPCI-neutral
Effective vintage
2026
latest effective year on the schedule
Maryland publishes fee schedules for two carve-outs: durable medical equipment (with prosthetics, orthotics, and supplies), and behavioral health, which runs fee-for-service through the state's Public Behavioral Health System with rates published by credential tier (psychiatrist, psychiatric NP, psychologist, licensed counselors), plus OMHC, SUD program, and ABA schedules. Other medical categories are paid through managed care and are not published as FFS rates.
Common physician procedures and what Maryland Medicaid pays
A curated sample of recognizable procedures from the 64-code schedule. Rates are the state's published fee-for-service amounts; the percentage compares each rate with the national Medicare amount for the same code.
| Code | Procedure | Maryland rate | % of Medicare |
|---|---|---|---|
| 36415 | Blood draw by needle from a vein | $22.02 | 235.8% |
| 96130 | Psychological test evaluation by professional, first hour | $179.37 | 144.8% |
| 96131 | Psychological test evaluation by professional, each added hour | $136.31 | 157.6% |
| 96136 | Psychological or neuropsych test administration, first 30 min | $73.96 | 169.1% |
| 96137 | Psychological or neuropsych test administration, each added 30 min | $68.96 | 186% |
| 96156 | Health behavior assessment or re-assessment | $167.27 | 155.5% |
| 96372 | Therapeutic or diagnostic injection, under the skin or into muscle | $14.75 | 96% |
| 97151 | Behavior identification assessment (ABA), each 15 minutes | $38.34 | -- |
| 97153 | Adaptive behavior treatment by protocol (ABA), each 15 minutes | $24.41 | -- |
| 97155 | Adaptive behavior treatment with protocol modification (ABA), each 15 min | $38.34 | -- |
| 97156 | Family adaptive behavior treatment guidance (ABA), each 15 minutes | $20.91 | -- |
| 97530 | Therapeutic activities for functional performance, each 15 minutes | $17.44 | 49.7% |
| 97535 | Self-care and home management training, each 15 minutes | $17.44 | 53.8% |
| 99202 | Office visit, new patient, straightforward (15-29 min) | $76.32 | 101.6% |
| 99203 | Office visit, new patient, low complexity (30-44 min) | $119.17 | 101.4% |
| 99204 | Office visit, new patient, moderate complexity (45-59 min) | $178.20 | 100.5% |
| 99205 | Office visit, new patient, high complexity (60-74 min) | $235.41 | 99.4% |
| 99211 | Office visit, established patient, minimal (may not need physician) | $24.87 | 102% |
| 99212 | Office visit, established patient, straightforward (10-19 min) | $60.09 | 101.1% |
| 99213 | Office visit, established patient, low complexity (20-29 min) | $97.02 | 101.9% |
| 99214 | Office visit, established patient, moderate complexity (30-39 min) | $136.43 | 100.6% |
| 99215 | Office visit, established patient, high complexity (40-54 min) | $191.23 | 99.4% |
| 99221 | Hospital admission, initial care, low complexity | $86.51 | 116.2% |
| 99222 | Hospital admission, initial care, moderate complexity | $136.02 | 116.4% |
| 99223 | Hospital admission, initial care, high complexity | $181.07 | 115.8% |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * show the schedule's representative published variant.
More Maryland Medicaid fee schedules
Physician rates in neighboring states
Frequently asked questions
What does Maryland Medicaid pay for physician and professional services?
Maryland Medicaid publishes 64 physician procedure rates effective 2026, paying a median 108.5% of the national Medicare amount for the same services. The schedule covers office visits, preventive care, surgery, and evaluation and management services. The table on this page shows published rates for common procedures; the complete all-codes schedule is available as a CSV download with a ProviderSignal Rates subscription.
How do Maryland's physician rates compare with Medicare?
Across physician codes with a national Medicare comparator, Maryland Medicaid pays a median 108.5% of the Medicare amount (GPCI-neutral national comparison). Individual codes vary widely, so check the per-code percentage in the table.
Do physician services need prior authorization in Maryland?
Maryland does not publish prior-authorization indicators on this fee schedule, so PA requirements must be confirmed through the state's provider manual or portal. Absence of a flag here means "not published", never "no PA required".
Where do these rates come from?
Directly from Maryland's published Medicaid fee-for-service schedule (effective 2026), collected and normalized by ProviderSignal across all 50 states + DC. Rates are re-collected on a rolling schedule and this page updates automatically. Procedure descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.