New Hampshire Medicaid Reimbursement Rates
What Medicaid pays for medical procedures and services in New Hampshire, based on 2024 claims data.
2024 Overview
Procedures
906
Total Claims
5.5M
Total Paid
$905.6M
Popular Services
Procedures
Showing 101–150 of 906 procedures, sorted by most claims.
| HCPCS Code | Description | Total Claims | Avg Payment | Min Payment | Max Payment |
|---|---|---|---|---|---|
| 87637 | Sarscov2&inf a&b&rsv amp prb | 8,653 | $116.09 | $0.00 | $149.76 |
| H2034 | A/d halfway house, per diem | 8,650 | $127.97 | $106.43 | $146.65 |
| S5130 | Homaker service nos per 15m | 8,606 | $96.79 | $16.57 | $381.87 |
| 80048 | Basic metabolic pnl total ca | 8,591 | $3.34 | $0.00 | $26.88 |
| D0230 | Intraoral periapical ea add | 8,131 | $14.31 | $4.02 | $19.42 |
| D0140 | Limit oral eval problm focus | 8,106 | $52.01 | $28.42 | $62.15 |
| 85027 | Complete cbc automated | 7,842 | $2.44 | $0.00 | $6.39 |
| 99204 | Office o/p new mod 45 min | 7,600 | $86.09 | $0.68 | $252.18 |
| 92340 | Fit spectacles monofocal | 7,554 | $28.83 | $9.37 | $100.00 |
| 90656 | Iiv3 vacc no prsv 0.5 ml im | 7,422 | $1.13 | $0.00 | $14.71 |
| 90846 | Family psytx w/o pt 50 min | 7,326 | $114.31 | $56.74 | $162.91 |
| G0467 | Fqhc visit, estab pt | 7,157 | $10.28 | $0.00 | $66.28 |
| S5102 | Adult day care per diem | 7,121 | $175.50 | $0.00 | $1,449.47 |
| 80305 | Drug test prsmv dir opt obs | 7,074 | $7.06 | $0.00 | $10.08 |
| D0330 | Panoramic image | 7,002 | $61.54 | $15.32 | $94.50 |
| D2940 | Place direct restoration | 6,977 | $60.73 | $35.47 | $78.96 |
| 90791 | Psych diagnostic evaluation | 6,955 | $134.16 | $0.00 | $176.06 |
| 99212 | Office o/p est sf 10 min | 6,930 | $26.93 | $0.00 | $92.87 |
| H0020 | Alcohol and/or drug services | 6,855 | $222.79 | $47.69 | $632.72 |
| D0603 | Caries risk assess high risk | 6,647 | $0.00 | $0.00 | $0.00 |
| A0427 | Als1-emergency | 6,502 | $247.44 | $29.43 | $499.05 |
| T1001 | Nursing assessment/evaluatn | 6,498 | $26.93 | $12.64 | $32.09 |
| G9012 | Other specified case mgmt | 6,294 | $122.19 | $86.60 | $172.23 |
| D7140 | Extraction erupted tooth/exr | 6,146 | $109.48 | $0.00 | $128.95 |
| 99484 | Care mgmt svc bhvl hlth cond | 6,127 | $1.75 | $0.00 | $6.12 |
| H2021 | Com wrap-around sv, 15 min | 6,103 | $306.18 | $265.91 | $354.76 |
| 96374 | Ther/proph/diag inj iv push | 6,061 | $28.91 | $0.00 | $138.93 |
| A0429 | Bls-emergency | 5,879 | $215.42 | $24.47 | $444.28 |
| 97153 | Adaptive behavior tx by tech | 5,860 | $213.37 | $59.55 | $381.93 |
| H2018 | Psysoc rehab svc, per diem | 5,749 | $55.51 | $21.02 | $113.86 |
| 84484 | Assay of troponin quant | 5,705 | $4.07 | $0.00 | $23.32 |
| H2011 | Crisis interven svc, 15 min | 5,641 | $255.34 | $137.19 | $536.35 |
| A7038 | Pos airway pressure filter | 5,637 | $6.36 | $0.43 | $17.57 |
| T1006 | Family/couple counseling | 5,607 | $270.38 | $241.84 | $281.18 |
| 99393 | Prev visit est age 5-11 | 5,597 | $70.99 | $0.00 | $531.65 |
| V2103 | Spherocylindr 4.00d/12-2.00d | 5,534 | $16.45 | $9.04 | $23.80 |
| D2930 | Prefab stnlss steel crwn pri | 5,501 | $214.99 | $118.25 | $246.35 |
| 81003 | Urinalysis auto w/o scope | 5,468 | $0.77 | $0.00 | $4.92 |
| 99392 | Prev visit est age 1-4 | 5,459 | $60.99 | $0.00 | $496.47 |
| 92004 | Compre oph exam new pt 1/> | 5,303 | $83.97 | $40.76 | $130.00 |
| A4927 | Non-sterile gloves | 5,303 | $21.19 | $9.38 | $25.01 |
| A9270 | Non-covered item or service | 5,248 | $0.12 | $0.00 | $4.21 |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to | 5,087 | $19.42 | $11.20 | $35.69 |
| 90999 | Unlisted dialysis procedure | 5,068 | $16.35 | $0.00 | $107.14 |
| 81001 | Urinalysis auto w/scope | 5,014 | $1.14 | $0.00 | $4.04 |
| Q9967 | Locm 300-399mg/ml iodine,1ml | 4,953 | $5.47 | $0.00 | $179.03 |
| 90472 | Immunization admin each add | 4,931 | $5.90 | $2.94 | $26.03 |
| 93306 | Tte w/doppler complete | 4,875 | $43.74 | $0.00 | $1,296.45 |
| 96127 | Brief emotional/behav assmt | 4,857 | $2.42 | $0.00 | $48.71 |
| 1036F | Tobacco non-user | 4,804 | $0.04 | $0.00 | $1.94 |