Medicaid Physician Payment Policy

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April 2016

Medicaid physician services are defined as covered medical services provided by physicians in a variety of settings, including clinics, community health centers, and private offices. The Medicaid statute also authorizes payment for services provided by other health care professionals, such as certified nurse practitioners and nurse-midwives. In fiscal year (FY) 2014, Medicaid spending on physician, dental, and other practitioners was about $19.8 billion (excluding managed care), or about 4.1 percent of total program spending.

States have broad flexibility to determine payments for physician services. In addition to this issue brief, MACPAC has documented state-specific methodologies in State Medicaid Fee-for-Service Physician Payment Policies.

Publication Type: Issue Briefs

Tags: fee for service, fee schedules, payment, physician fees, physicians, quality, rate setting