Medicaid Benefits: Online Database

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Benefits by Service: Nurse Practitioner Services (October 2008) Definition/Notes

Note: Totals include 50 states and D.C.

"Benefits Covered" Totals

"Benefits Not Covered" Totals

Is the benefit covered?

Is there a co-payment requirement?

Yes: 21

No: 29

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Alabama
Yes	$1/office visit		14 ambulatory visits/year irrespective of setting, 16 inpatient hospital visits/year, visits included in physician visit limitation - limit doesn't apply to family planning	Fee for service, some services paid 85% of physician fee	CN
Alaska
Yes				Fee for service at 85% of physician fee	CN
Arizona
Yes				Fee for service at 90% of physician fee	CN & MN
Arkansas
Yes			12 visits/year irrespective of setting included in limits for other specified practitioners	Fee for service at 80% of physician fee	CN & MN
California
No
Colorado
Yes				Fee for service	CN
Connecticut
Yes				Fee for service at 90% of physician fee	CN & MN
Delaware
Yes				Fee for service	CN
District of Columbia
Yes				Fee for service	CN & MN
Florida
Yes	$2/day for office or outpatient hospital visit		1 non-emergency visit/day, 1 routine physical exam/year, 10 prenatal visits/pregnancy and 2 postpartum visits/pregnancy	Fee for service at 80% of physician fee	CN & MN
Georgia
Yes	$.50-$3 for selected services dependng on payment rate		12 office visits/year, 1 inpatient hospital visit/day, 12 nursing facility visits/year	Fee for service at 90% of physician fee	CN & MN
Hawaii
Yes				Fee for service	CN & MN
Idaho
Yes				Fee for service at 85% of physician fee	CN
Illinois
Yes				Fee for service at physician fee	CN & MN
Indiana
Yes				Fee for service at 75% of physician fee	CN
Iowa
Yes		Specified procedures		Fee for service	CN & MN
Kansas
Yes			12 office visits/year, 1 inpatient hospital visit/day, 1 nursing facility visit/month	Fee for service at 75% of physician fee	CN & MN
Kentucky
Yes	A - $2/visit except maternity care			Fee for service at 75% of physician fee	A, B, C & D - See state-specific FN
Louisiana
Yes			12 ambulatory visits/year irrespective of setting, 1 inpatient hospital visit/day	Fee for service at 80% of physician fee with some exceptions	CN & MN
Maine
Yes		Specified procedures and services		Fee for service	CN & MN
Maryland
Yes				Fee for service	CN & MN
Massachusetts
Yes				Fee for service	CN & MN
Michigan
Yes	$2/office visit not associated with pregnancy or family planning	Selected procedures		Fee for service	CN & MN
Minnesota
Yes	$3/visit for non-preventive service			Fee for service	A & B - See state-specific FN
Mississippi
Yes	$3/visit		12 office, rural health or outpatient visits/year, 36 nursing facility visits/year, visits included in physician visit limitations	Fee for service at 90% of physician fee	CN
Missouri
Yes	$1/day			Fee for service	CN & MN
Montana
Yes	$4/visit			Fee for service, some services paid 90% of physician fee	A & B - See state-specific FN
Nebraska
Yes	$2/visit, not applicable to primary care services - see state-specific FN			Fee for service	CN & MN
Nevada
Yes				Fee for service	CN
New Hampshire
Yes			18 ambulatory visits/year irrespective of setting	Fee for service	CN & MN
New Jersey
Yes				Fee for service at 95% of non-specialist physician fee	CN & MN
New Mexico
Yes	A - $5/visit, B - $7/visit non-preventive services - see state-specific FN			Fee for service at 90% of physician fee for independent practitioners	CN
New York
Yes				Fee for service	CN & MN
North Carolina
Yes	$3/visit	Specified services	22 ambulatory visits/year included in limits with other specified practitioners - limits set annually by the legislature	Fee for service	CN & MN
North Dakota
Yes	$2/visit			Fee for service at 75% of physician fee	CN & MN
Ohio
Yes				Fee for service	CN
Oklahoma
Yes			4 non-emergency ambulatory visits/month included in physician limit	Fee for service	CN
Oregon
Yes	A - $3/visit			Fee for service	A & B - See state-specific FN
Pennsylvania
Yes	$.50-$3/service, depending on payment		Frequency limits vary by service	Fee for service	CN & MN
Rhode Island
Yes				Fee for service	CN & MN - see state-specific FN
South Carolina
Yes	$2/visit - applicable to specified E&M services only		12 visits/year, visits count toward physician visit limit	Fee for service at 80% of physician fee	CN
South Dakota
Yes	$3/visit		Substance abuse treatment not covered	Fee for service at 90% of physician fee	CN
Tennessee
Yes					A & B - See state-specific FN
Texas
Yes		Yes		Fee for service, some services paid 92% of physician fee	CN & MN
Utah
Yes	A & B - $3/visit, C - $5/visit		C - primary care only, including routine physical exams	Fee for service, rural nurse practitioners may be paid higher fees	A, B & C - See state-specific FN
Vermont
Yes				Fee for service	A & B - See state-specific FN
Virginia
Yes	$1/visit		Services limited by scope of practice, routine physical exams not covered	Fee for service	CN & MN
Washington
Yes				Fee for service, fixed rate per visit to nurse practitioner clinics	CN & MN
West Virginia
Yes				Fee for service	A & B
Wisconsin
Yes	$.50-$3, depending on service, maximum $30/year/provider		1 nursing facility visit/month	Fee for service	CN & MN
Wyoming
Yes	$2/office or home visit			Fee for service at 83% of physician fee	CN
American Samoa
Yes					See territory-specific FN
Guam
Yes				Fee for service	CN
Northern Mariana Islands
No
Puerto Rico
Yes				Fee for service for contracted staff	CN & MN
Virgin Islands
Yes				Fee for service	CN

Definition/Notes: Link to Nurse Practitioner Services Footnote


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