Medicaid Benefits: Nurse Practitioner Services

This data is presented as an interactive tool that allows users to: filter by timeframe/year, select specific data columns (distributions), filter by state or geography, and view the data as a table, map, or trend chart.

2018

Location	Benefit Covered	Coverage Code	Copayment Required?	Limits on Services	Prior Approval Required	Reimbursement Methodology
United States	Yes - 51	2018 data limited to CN	Yes - 21	Yes - 14	Included in "Limits on Services" for 2018	Not included in 2018 survey
Alabama	Yes - Mandatory	CN	$1.30 - $3.90 each visit	limit of 14 office visits and 16 inpatient hospital visits	-	-
Alaska	Yes - Mandatory	CN	$3	No	-	-
Arizona	Yes - Mandatory	CN	No	No	-	-
Arkansas	Yes - Mandatory	CN	NR	NR	-	-
California	Yes - Mandatory	CN	No	Limited to services within scope of practice, physician supervision required.	-	-
Colorado	Yes - Mandatory	CN	$2 per visit	No	-	-
Connecticut	Yes - Mandatory	CN	No	No	-	-
Delaware	Yes - Mandatory	CN	No	NR	-	-
District of Columbia	Yes - Mandatory	CN	No	No	-	-
Florida	Yes - Mandatory	CN	Nurse practitioner services, per provider or group provider, $2.00 per day	Adult Health Screening Services: One adult health screening every 365 days, for recipients age 21 years and older. Services in intermediate care facilities and nursing facilities that provide room, board, and other services on a long-term basis but does not include a medical component: One evaluation and management visit per month, per recipient. Office Visits: Up to two office visits per month, per specialty, for recipients age 21 years and older (pregnant women are exempt).	-	-
Georgia	Yes - Mandatory	CN	$2 copay	Over 12 visits per year must be prior authorized.	-	-
Hawaii	Yes - Mandatory	CN	No	No	-	-
Idaho	Yes - Mandatory	CN	No	No	-	-
Illinois	Yes - Mandatory	CN	NR	NR	-	-
Indiana	Yes - Mandatory	CN	No	Prior authorization required after 30 E/M visits	-	-
Iowa	Yes - Mandatory	CN	NR	NR	-	-
Kansas	Yes - Mandatory	CN	No	No	-	-
Kentucky	Yes - Mandatory	CN	$3	Psychiatry services limited to 4 visits per year; one E&M service per provider per member per year	-	-
Louisiana	Yes - Mandatory	CN	No	NR	-	-
Maine	Yes - Mandatory	CN	No	No	-	-
Maryland	Yes - Mandatory	CN	No	No	-	-
Massachusetts	Yes - Mandatory	CN	No	No	-	-
Michigan	Yes - Mandatory	CN	$2/visit	No	-	-
Minnesota	Yes - Mandatory	CN	$3 copay for non-preventive office visits	No	-	-
Mississippi	Yes - Mandatory	CN	$3 per visit	Applies to the 12 physician office visit limit per state fiscal year	-	-
Missouri	Yes - Mandatory	CN	Yes - Not Specified	There are daily quantity limits on services.	-	-
Montana	Yes - Mandatory	CN	Income at or below 100% FPL - $4 per visit; above FPL - 10% of payment amount	No	-	-
Nebraska	Yes - Mandatory	CN	$2 per visit if furnished as a speciality office visit - non-primary care	No	-	-
Nevada	Yes - Mandatory	CN	NR	NR	-	-
New Hampshire	Yes - Mandatory	CN	No	NR	-	-
New Jersey	Yes - Mandatory	CN	No	No	-	-
New Mexico	Yes - Mandatory	CN	$7 for WDI recipients	No	-	-
New York	Yes - Mandatory	CN	NR	NR	-	-
North Carolina	Yes - Mandatory	CN	$1 - $3 depending on the service	NR	-	-
North Dakota	Yes - Mandatory	CN	$2 per visit	No	-	-
Ohio	Yes - Mandatory	CN	No	No	-	-
Oklahoma	Yes - Mandatory	CN	$4 per visit	Services are subject to the existing visit limitation of 4 visits per month.	-	-
Oregon	Yes - Mandatory	CN	No	Coverage is based upon Oregon's 1115 waiver and Health Evidence Review Commission's prioritized list of health services	-	-
Pennsylvania	Yes - Mandatory	CN	Sliding scale based on the Medicaid fee for the service: $0.65 - $3.80	No	-	-
Rhode Island	Yes - Mandatory	CN	No	No	-	-
South Carolina	Yes - Mandatory	CN	NR	NR	-	-
South Dakota	Yes - Mandatory	CN	$3/visit	No	-	-
Tennessee	Yes - Mandatory	CN	No	No	-	-
Texas	Yes - Mandatory	CN	No	No	-	-
Utah	Yes - Mandatory	CN	$4 per visit	No	-	-
Vermont	Yes - Mandatory	CN	No	5 office visits per month; 1 acute care hospital visit per day; 1 nursing facility visit per week; prior authorization required for certain services and to exceed stated visit limits	-	-
Virginia	Yes - Mandatory	CN	No	NR	-	-
Washington	Yes - Mandatory	CN	No	Some may require Prior authorization	-	-
West Virginia	Yes - Mandatory	CN	No	No	-	-
Wisconsin	Yes - Mandatory	CN	$0.50 - $3, depending on the service. Capped at $30 per provider or clinic, per calendar year	A small number of services require prior approval.	-	-
Wyoming	Yes - Mandatory	CN	$2.45 for non - emergent	Prior authorization is required after the first 12 visits to confirm ongoing medical necessity	-	-

2012

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 55 No - 1		Yes - 24 No - 31
Alabama	Yes	CN	$1/office visit	14 ambulatory visits/year irrespective of setting, visits included in physician visit limitation - limit does not apply to family planning		Fee for service, some services paid 85% of physician fee
Alaska	Yes	CN				Fee for service at 85% of physician fee
American Samoa	Yes	See territory-specific FN
Arizona	Yes	CN & MN				Fee for service at 90% of physician fee
Arkansas	Yes	CN & MN		12 visits/year irrespective of setting included in limits for other specified practitioners		Fee for service at 80% of physician fee
California	Yes	CN & MN		Limited to services within scope of practice, physician supervision required		Fee for service
Colorado	Yes	CN			Specified services	Fee for service
Connecticut	Yes	CN & MN				Fee for service at 90% of physician fee
Delaware	Yes	CN				Fee for service
District of Columbia	Yes	CN & MN				Fee for service
Florida	Yes	CN & MN	$2/day for office or non-emergency hospital visit	2 primary care visits/month for non-pregnant adults, 1 non-emergency visit/specialty/day, 1 routine physical exam/year, 1 visit/specialty/month for supervision of chronic illness, 10 prenatal visits/normal pregnancy and 2 postpartum visits within 90 days of delivery /pregnancy		Fee for service at 80% of physician fee
Georgia	Yes	CN & MN	$.50-$3 depending 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
Guam	Yes	CN				Fee for service at 85% of physician fee on Medicare fee schedule
Hawaii	Yes	CN & MN				Fee for service
Idaho	Yes	CN				Fee for service at 85% of physician fee
Illinois	Yes	CN & MN	$3.65/office visit			Fee for service at physician fee
Indiana	Yes	CN				Fee for service, independent practitioners paid 75% of physician fee
Iowa	Yes	CN & MN		Limited to services within scope of practice and to those payable to physicians	Specified procedures and services	Fee for service
Kansas	Yes	CN & MN	$2/visit	12 office visits/year, 1 inpatient hospital visit/day, 1 nursing facility visit/month		Fee for service at 75% of physician fee
Kentucky	Yes	A, B & C - See state-specific FN	A - $2/visit except maternity care and preventive services			Fee for service at 75% of physician fee
Louisiana	Yes	CN & MN		12 ambulatory visits/year irrespective of setting included in physician visit limit, 1 inpatient hospital visit/day		Fee for service at 80% of physician fee with some exceptions
Maine	Yes	CN & MN			Specified procedures and services	Fee for service
Maryland	Yes	CN & MN				Fee for service
Massachusetts	Yes	CN & MN				Fee for service
Michigan	Yes	CN & MN	$2/office visit not associated with pregnancy or family planning	Services limited by scope of practice	Selected procedures	Fee for service
Minnesota	Yes	A & B - See state-specific FN	$3/visit for non-preventive and non-maternity service			Fee for service
Mississippi	Yes	CN	$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
Missouri	Yes	CN	$1/day			Fee for service
Montana	Yes	A & B - See state-specific FN	$4/visit			Fee for service, some services paid 90% of physician fee
Nebraska	Yes	CN & MN	$2/visit, not applicable to primary care services - see state-specific FN			Fee for service
Nevada	Yes	CN				Fee for service
New Hampshire	Yes	CN & MN		18 psychotherapy visits/year irrespective of setting		Fee for service
New Jersey	Yes	CN & MN				Fee for service at 95% of non-specialist physician fee
New Mexico	Yes	CN	A - $0-$7/visit depending on income, B - $7/visit non-preventive services - see state-specific FN			Fee for service at 90% of physician fee schedule for independent practitioners
New York	Yes	CN & MN				Fee for service
North Carolina	Yes	CN & MN	$3/visit for non-pregnant adults	22 ambulatory visits/year included in limits with other specified practitioners - limits set annually by the legislature	Specified services	Fee for service
North Dakota	Yes	CN & MN	$2/visit			Fee for service at 75% of physician fee
Northern Mariana Islands	No
Ohio	Yes	CN				Fee for service
Oklahoma	Yes	CN	$3/visit	4 non-emergency ambulatory visits/month included in physician limit		Fee for service
Oregon	Yes	A & B - See state-specific FN	A - $3/visit	Services limited to funded conditions on the priority list		Fee for service, using Medicare Relative Value Units and a state conversion factor
Pennsylvania	Yes	CN & MN	$.65-$3.80/service, depending on payment rate	Frequency limits vary by service		Fee for service
Puerto Rico	Yes	CN & MN				Service is included in the capitated rate paid to managed care plans
Rhode Island	Yes	See state-specific FN				Fee for service
South Carolina	Yes	CN	$3.30/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
South Dakota	Yes	CN	$3/visit	Substance abuse treatment not covered		Fee for service at 90% of physician fee
Tennessee	Yes	A, B & C - See state-specific FN				See state-specific FN
Texas	Yes	CN & MN			Yes	Fee for service, some services paid 92% of physician fee
Utah	Yes	A, B & C - See state-specific FN	A & B- $3/non-preventive care visit, C - $5/visit	C - primary care only, including routine physical exams		Fee for service, rural nurse practitioners may be paid higher fees
Vermont	Yes	A & B - See state-specific FN				Fee for service, using Medicare Relative Value Units and a state conversion factor
U.S. Virgin Islands	Yes	CN				Fee for service
Virginia	Yes	CN & MN	$1/visit	Services limited by scope of practice, routine physical exams not covered		Fee for service
Washington	Yes	CN & MN				Fee for service, fixed rate per visit to nurse practitioner clinics
West Virginia	Yes	A, B & C				Fee for service
Wisconsin	Yes	CN & MN	$.50-$3, depending on service, maximum $30/year/provider	1 nursing facility visit/month		Fee for service
Wyoming	Yes	CN	$2.45/office or home visit	12 visits/year, in combination with physician, clinic and outpatient hosp visits		Fee for service at 83% of physician fee

2010

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 55 No - 1		Yes - 23 No - 32
Alabama	Yes	CN	$1/office visit	14 ambulatory visits/year irrespective of setting, 16 inpatient hospital visits/year, visits included in physician visit limitation - limit does not apply to family planning		Fee for service, some services paid 85% of physician fee
Alaska	Yes	CN				Fee for service at 85% of physician fee
American Samoa	Yes	See territory-specific FN
Arizona	Yes	CN & MN				Fee for service at 90% of physician fee
Arkansas	Yes	CN & MN		12 visits/year irrespective of setting included in limits for other specified practitioners		Fee for service at 80% of physician fee
California	Yes	CN & MN		Limited to services within scope of practice, physician supervision required		Fee for service
Colorado	Yes	CN			Specified services	Fee for service
Connecticut	Yes	CN & MN				Fee for service at 90% of physician fee
Delaware	Yes	CN				Fee for service
District of Columbia	Yes	CN & MN				Fee for service
Florida	Yes	CN & MN	$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
Georgia	Yes	CN & MN	$.50-$3 for selected services depending 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
Guam	Yes	CN				Fee for service
Hawaii	Yes	CN & MN				Fee for service
Idaho	Yes	CN				Fee for service at 85% of physician fee
Illinois	Yes	CN & MN				Fee for service at physician fee
Indiana	Yes	CN				Fee for service at 75% of physician fee
Iowa	Yes	CN & MN			Specified procedures	Fee for service
Kansas	Yes	CN & MN	$2/visit	12 office visits/year, 1 inpatient hospital visit/day, 1 nursing facility visit/month		Fee for service at 75% of physician fee
Kentucky	Yes	A, B & C - See state-specific FN	A - $2/visit except maternity care and preventive services			Fee for service at 75% of physician fee
Louisiana	Yes	CN & MN		12 ambulatory visits/year irrespective of setting, 1 inpatient hospital visit/day		Fee for service at 80% of physician fee with some exceptions
Maine	Yes	CN & MN			Specified procedures and services	Fee for service
Maryland	Yes	CN & MN				Fee for service
Massachusetts	Yes	CN & MN				Fee for service
Michigan	Yes	CN & MN	$2/office visit not associated with pregnancy or family planning		Selected procedures	Fee for service
Minnesota	Yes	A & B - See state-specific FN	B - $3/visit for non-preventive service			Fee for service
Mississippi	Yes	CN	$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
Missouri	Yes	CN	$1/day			Fee for service
Montana	Yes	A & B - See state-specific FN	$4/visit			Fee for service, some services paid 90% of physician fee
Nebraska	Yes	CN & MN	$2/visit, not applicable to primary care services - see state-specific FN			Fee for service
Nevada	Yes	CN				Fee for service
New Hampshire	Yes	CN & MN		18 ambulatory visits/year irrespective of setting		Fee for service
New Jersey	Yes	CN & MN				Fee for service at 95% of non-specialist physician fee
New Mexico	Yes	CN	A - $0-$7/visit depending on income, B - $7/visit non-preventive services - see state-specific FN			Fee for service at 90% of physician fee schedule for independent practitioners
New York	Yes	CN & MN				Fee for service
North Carolina	Yes	CN & MN	$3/visit	22 ambulatory visits/year included in limits with other specified practitioners - limits set annually by the legislature	Specified services	Fee for service
North Dakota	Yes	CN & MN	$2/visit			Fee for service at 75% of physician fee
Northern Mariana Islands	No
Ohio	Yes	CN				Fee for service
Oklahoma	Yes	CN	$3/visit	4 non-emergency ambulatory visits/month included in physician limit		Fee for service
Oregon	Yes	A & B - See state-specific FN	A - $3/visit	Services limited to funded conditions on the priority list		Fee for service, using Medicare Relative Value Units and a state conversion factor
Pennsylvania	Yes	CN & MN	$.50-$3/service, depending on payment	Frequency limits vary by service		Fee for service
Puerto Rico	Yes	CN & MN				Service is included in the capitated rate paid to managed care plans
Rhode Island	Yes	See state-specific FN				Fee for service
South Carolina	Yes	CN	$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
South Dakota	Yes	CN	$3/visit	Substance abuse treatment not covered		Fee for service at 90% of physician fee
Tennessee	Yes	A & B - See state-specific FN				See state-specific FN
Texas	Yes	CN & MN			Yes	Fee for service, some services paid 92% of physician fee
Utah	Yes	A, B & C - See state-specific FN	A & B - $3/non-preventive care visit, C - $5/visit	C - primary care only, including routine physical exams		Fee for service, rural nurse practitioners may be paid higher fees
Vermont	Yes	A & B - See state-specific FN				Fee for service, using Medicare Relative Value Units and a state conversion factor
U.S. Virgin Islands	Yes	CN				Fee for service
Virginia	Yes	CN & MN	$1/visit	Services limited by scope of practice, routine physical exams not covered		Fee for service
Washington	Yes	CN & MN				Fee for service, fixed rate per visit to nurse practitioner clinics
West Virginia	Yes	A, B & C				Fee for service
Wisconsin	Yes	CN & MN	$.50-$3, depending on service, maximum $30/year/provider	1 nursing facility visit/month		Fee for service
Wyoming	Yes	CN	$2/office or home visit			Fee for service at 83% of physician fee

2008

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 54 No - 2		Yes - 22 No - 32
Alabama	Yes	CN	$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
Alaska	Yes	CN				Fee for service at 85% of physician fee
American Samoa	Yes	See territory-specific FN
Arizona	Yes	CN & MN				Fee for service at 90% of physician fee
Arkansas	Yes	CN & MN		12 visits/year irrespective of setting included in limits for other specified practitioners		Fee for service at 80% of physician fee
California	No
Colorado	Yes	CN				Fee for service
Connecticut	Yes	CN & MN				Fee for service at 90% of physician fee
Delaware	Yes	CN				Fee for service
District of Columbia	Yes	CN & MN				Fee for service
Florida	Yes	CN & MN	$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
Georgia	Yes	CN & MN	$.50-$3 for selected services depending 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
Guam	Yes	CN				Fee for service
Hawaii	Yes	CN & MN				Fee for service
Idaho	Yes	CN				Fee for service at 85% of physician fee
Illinois	Yes	CN & MN				Fee for service at physician fee
Indiana	Yes	CN				Fee for service at 75% of physician fee
Iowa	Yes	CN & MN			Specified procedures	Fee for service
Kansas	Yes	CN & MN	$2/visit	12 office visits/year, 1 inpatient hospital visit/day, 1 nursing facility visit/month		Fee for service at 75% of physician fee
Kentucky	Yes	A, B & C - See state-specific FN	A - $2/visit except maternity care			Fee for service at 75% of physician fee
Louisiana	Yes	CN & MN		12 ambulatory visits/year irrespective of setting, 1 inpatient hospital visit/day		Fee for service at 80% of physician fee with some exceptions
Maine	Yes	CN & MN			Specified procedures and services	Fee for service
Maryland	Yes	CN & MN				Fee for service
Massachusetts	Yes	CN & MN				Fee for service
Michigan	Yes	CN & MN	$2/office visit not associated with pregnancy or family planning		Selected procedures	Fee for service
Minnesota	Yes	A & B - See state-specific FN	$3/visit for non-preventive service			Fee for service
Mississippi	Yes	CN	$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
Missouri	Yes	CN	$1/day			Fee for service
Montana	Yes	A & B - See state-specific FN	$4/visit			Fee for service, some services paid 90% of physician fee
Nebraska	Yes	CN & MN	$2/visit, not applicable to primary care services - see state-specific FN			Fee for service
Nevada	Yes	CN				Fee for service
New Hampshire	Yes	CN & MN		18 ambulatory visits/year irrespective of setting		Fee for service
New Jersey	Yes	CN & MN				Fee for service at 95% of non-specialist physician fee
New Mexico	Yes	CN	A - $5/visit, B - $7/visit non-preventive services - see state-specific FN			Fee for service at 90% of physician fee for independent practitioners
New York	Yes	CN & MN				Fee for service
North Carolina	Yes	CN & MN	$3/visit	22 ambulatory visits/year included in limits with other specified practitioners - limits set annually by the legislature	Specified services	Fee for service
North Dakota	Yes	CN & MN	$2/visit			Fee for service at 75% of physician fee
Northern Mariana Islands	No
Ohio	Yes	CN				Fee for service
Oklahoma	Yes	CN		4 non-emergency ambulatory visits/month included in physician limit		Fee for service
Oregon	Yes	A & B - See state-specific FN	A - $3/visit			Fee for service
Pennsylvania	Yes	CN & MN	$.50-$3/service, depending on payment	Frequency limits vary by service		Fee for service
Puerto Rico	Yes	CN & MN				Fee for service for contracted staff
Rhode Island	Yes	CN & MN - see state-specific FN				Fee for service
South Carolina	Yes	CN	$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
South Dakota	Yes	CN	$3/visit	Substance abuse treatment not covered		Fee for service at 90% of physician fee
Tennessee	Yes	A & B - See state-specific FN
Texas	Yes	CN & MN			Yes	Fee for service, some services paid 92% of physician fee
Utah	Yes	A, B & C - See state-specific FN	A & B - $3/non-preventive care visit, C - $5/visit	C - primary care only, including routine physical exams		Fee for service, rural nurse practitioners may be paid higher fees
Vermont	Yes	A & B - See state-specific FN				Fee for service
U.S. Virgin Islands	Yes	CN				Fee for service
Virginia	Yes	CN & MN	$1/visit	Services limited by scope of practice, routine physical exams not covered		Fee for service
Washington	Yes	CN & MN				Fee for service, fixed rate per visit to nurse practitioner clinics
West Virginia	Yes	A, B & C				Fee for service
Wisconsin	Yes	CN & MN	$.50-$3, depending on service, maximum $30/year/provider	1 nursing facility visit/month		Fee for service
Wyoming	Yes	CN	$2/office or home visit			Fee for service at 83% of physician fee

2006

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 54 No - 2		Yes - 22 No - 32
Alabama	Yes	CN	$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
Alaska	Yes	CN				Fee for service at 85% of physician fee
American Samoa	Yes	See territory-specific FN
Arizona	Yes	CN & MN				Fee for service at 90% of physician fee
Arkansas	Yes	CN & MN		12 visits/year irrespective of setting		Fee for service at 80% of physician fee
California	No
Colorado	Yes	CN				Fee for service
Connecticut	Yes	CN & MN				Fee for service at 90% of physician fee
Delaware	Yes	CN				Fee for service
District of Columbia	Yes	CN & MN				Fee for service
Florida	Yes	CN & MN	$2/office or outpatient hospital visit	1 non-emergency visit/day, 1 routine physical exam/year		Fee for service at 80% of physician fee
Georgia	Yes	CN & MN	$.50-$3 for selected services depending 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
Guam	Yes	CN				Fee for service
Hawaii	Yes	CN & MN				Fee for service
Idaho	Yes	CN		Naturopathic services not covered		Fee for service at 85% of physician fee
Illinois	Yes	CN & MN				Fee for service at physician fee
Indiana	Yes	CN				Fee for service at 75% of physician fee
Iowa	Yes	CN & MN			Specified procedures	Fee for service
Kansas	Yes	CN & MN	$2/visit	12 office visits/year, 1 inpatient hospital visit/day, 1 nursing facility visit/month		Fee for service at 75% of physician fee
Kentucky	Yes	A, B & C - See state-specific FN	A - $2/visit except maternity care			Fee for service at 75% of physician fee
Louisiana	Yes	CN & MN		12 ambulatory visits/year irrespective of setting, 1 inpatient hospital visit/day		Fee for service at 80% of physician fee with some exceptions
Maine	Yes	CN & MN			Specified procedures and services	Fee for service
Maryland	Yes	CN & MN				Fee for service
Massachusetts	Yes	CN & MN				Fee for service
Michigan	Yes	CN & MN	$2/office visit not associated with pregnancy or family planning			Fee for service
Minnesota	Yes	A & B - See state-specific FN	$3/visit for non-preventive service			Fee for service
Mississippi	Yes	CN	$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
Missouri	Yes	CN	$1/day			Fee for service
Montana	Yes	A & B - See state-specific FN	$4/visit			Fee for service, some services paid 90% of physician fee
Nebraska	Yes	CN & MN	$2/visit, not applicable to primary care services - see state-specific FN			Fee for service
Nevada	Yes	CN				Fee for service
New Hampshire	Yes	CN & MN		18 ambulatory visits/year irrespective of setting		Fee for service
New Jersey	Yes	CN & MN				Fee for service at 95% of non-specialist physician fee
New Mexico	Yes	CN	A - $5/visit, B - $7/visit non-preventive services - see state-specific FN			Fee for service at 90% of physician fee for independent practitioners
New York	Yes	CN & MN				Fee for service
North Carolina	Yes	CN & MN	$3/visit	24 ambulatory visits/year included in limits with other specified practitioners	Specified services	Fee for service
North Dakota	Yes	CN & MN	$2/visit			Fee for service at 75% of physician fee
Northern Mariana Islands	No
Ohio	Yes	CN				Fee for service
Oklahoma	Yes	CN				Fee for service
Oregon	Yes	A & B - See state-specific FN	A - $3/visit			Fee for service
Pennsylvania	Yes	CN & MN	$.50-$3/service, depending on payment			Fee for service
Puerto Rico	Yes	CN & MN				Fee for service for contracted staff
Rhode Island	Yes	CN & MN - see state-specific FN				Fee for service
South Carolina	Yes	CN	$2/visit			Fee for service at 80% of physician fee
South Dakota	Yes	CN	$3/visit	Substance abuse treatment not covered		Fee for service at 90% of physician fee
Tennessee	Yes	A & B - See state-specific FN
Texas	Yes	CN & MN			Yes	Fee for service, some services paid 92% of physician fee
Utah	Yes	A, B & C - See state-specific FN	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
Vermont	Yes	A & B - See state-specific FN				Fee for service
U.S. Virgin Islands	Yes	CN				Fee for service
Virginia	Yes	CN & MN	$1/visit	Routine physical exams not covered		Fee for service
Washington	Yes	CN & MN				Fee for service, fixed rate per visit to nurse practitioner clinics
West Virginia	Yes	CN & MN				Fee for service
Wisconsin	Yes	CN & MN	$.50-$3, depending on service, maximum $30/year/provider	1 nursing facility visit/month		Fee for service
Wyoming	Yes	CN	$2/office or home visit			Fee for service at 83% of physician fee

2004

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 53 No - 3		Yes - 19 No - 34
Alabama	Yes	CN	$1/office visit	14 ambulatory visits/year irrespective of setting, 16 inpatient hospital visits/year, visits included in physician visit limitations		Fee for service, some services paid 85% of physician fee
Alaska	Yes	CN				Fee for service at 85% of physician fee
American Samoa	Yes	See territory-specific FN
Arizona	Yes	CN & MN				Fee for service at 90% of physician fee
Arkansas	Yes	CN & MN		12 visits/year irrespective of setting		Fee for service at 80% of physician fee
California	No
Colorado	Yes	CN				Fee for service
Connecticut	Yes	CN & MN				Fee for service at 90% of physician fee
Delaware	Yes	CN				Fee for service
District of Columbia	Yes	CN & MN				Fee for service
Florida	Yes	CN & MN	$2/office or outpatient hospital visit	1 non-emergency visit/day, 1 routine physical exam/year		Fee for service at 80% of physician fee
Georgia	Yes	CN & MN	$2/office visit	12 office visits/year, 1 inpatient hospital visit/day, 12 nursing facility visits/year		Fee for service at 90% of physician fee
Guam	Yes	CN				Fee for service
Hawaii	Yes	CN & MN				Fee for service
Idaho	Yes	CN		Naturopathic services not covered		Fee for service at 85% of physician fee
Illinois	Yes	CN & MN				Fee for service at 70% of physician fee
Indiana	Yes	CN				Fee for service at 75% of physician fee
Iowa	Yes	CN & MN			Specified procedures	Fee for service
Kansas	Yes	CN & MN	$2/visit	12 office visits/year, 1 inpatient hospital visit/day, 1 nursing facility visit/month		Fee for service at 75% of physician fee
Kentucky	Yes	CN & MN				Fee for service at 75% of physician fee
Louisiana	Yes	CN & MN		12 ambulatory visits/year irrespective of setting, 1 inpatient hospital visit/day		Fee for service at 80% of physician fee with some exceptions
Maine	Yes	CN & MN			Specified procedures and services	Fee for service
Maryland	Yes	CN & MN				Fee for service
Massachusetts	Yes	CN & MN				Fee for service
Michigan	Yes	CN & MN				Fee for service
Minnesota	Yes	A & B - See state-specific FN	A - $3/visit for non-preventive service			Fee for service
Mississippi	Yes	CN	$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
Missouri	Yes	CN	$1/visit (outpatient hospital or emergency room only)			Fee for service
Montana	Yes	A & B - See state-specific FN	$4/visit			Fee for service, some services paid 90% of physician fee
Nebraska	Yes	CN & MN	$2/visit (specialist only) - see state-specific FN			Fee for service
Nevada	Yes	CN				Fee for service
New Hampshire	Yes	CN & MN		18 ambulatory visits/year irrespective of setting		Fee for service
New Jersey	Yes	CN & MN				Fee for service at 95% of non-specialist physician fee
New Mexico	Yes	CN	B - $7/visit non-preventive services - see state-specific FN			Fee for service at 90% of physician fee for independent practitioners
New York	Yes	CN & MN				Fee for service
North Carolina	Yes	CN & MN	$3/visit	24 ambulatory visits/year included in limits with other specified practitioners	Specified services	Fee for service
North Dakota	Yes	CN & MN	$2/visit			Fee for service at 75% of physician fee
Northern Mariana Islands	No
Ohio	Yes	CN				Fee for service
Oklahoma	Yes	CN				Fee for service
Oregon	Yes	A & B - See state-specific FN	A - $3/visit			Fee for service
Pennsylvania	Yes	CN & MN				Fee for service with maximums/day dependent on setting
Puerto Rico	No
Rhode Island	Yes	CN & MN - see state-specific FN				Fee for service
South Carolina	Yes	CN	$2/visit			Fee for service at 80% of physician fee
South Dakota	Yes	CN	$2/visit	Substance abuse treatment not covered		Fee for service at 90% of physician fee
Tennessee	Yes	A & B - See state-specific FN
Texas	Yes	CN & MN			Yes	Fee for service, some services paid 85% of physician fee
Utah	Yes	A, B & C - See state-specific FN	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
Vermont	Yes	A & B - See state-specific FN				Fee for service
U.S. Virgin Islands	Yes	CN				Fee for service
Virginia	Yes	CN & MN	$1/visit	Routine physical exams not covered		Fee for service
Washington	Yes	CN & MN				Fee for service, fixed rate per visit to nurse practitioner clinics
West Virginia	Yes	CN & MN				Fee for service
Wisconsin	Yes	CN & MN	$.50-$3, depending on service, maximum $30/year/provider	1 nursing facility visit/month		Fee for service
Wyoming	Yes	CN	$2/office or home visit			Fee for service at 83% of physician fee

2003

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 53 No - 3		Yes - 18 No - 35
Alabama	Yes	CN	$1/office visit	14 ambulatory visits/year irrespective of setting, 16 inpatient hospital visits/year, visits included in physician visit limitations		Fee for service, some services paid 85% of physician fee
Alaska	Yes	CN				Fee for service at 85% of physician fee
American Samoa	Yes	See territory-specific FN
Arizona	Yes	CN & MN				Fee for service at 90% of physician fee
Arkansas	Yes	CN & MN		12 visits/year irrespective of setting		Fee for service at 80% of physician fee
California	No
Colorado	Yes	CN				Fee for service
Connecticut	Yes	CN & MN				Fee for service at 90% of physician fee
Delaware	Yes	CN				Fee for service
District of Columbia	Yes	CN & MN				Fee for service
Florida	Yes	CN & MN	$2/office or outpatient hospital visit	1 non-emergency visit/day, 1 routine physical exam/year		Fee for service at 80% of physician fee
Georgia	Yes	CN & MN	$2/office visit	12 office visits/year, 1 inpatient hospital visit/day, 12 nursing facility visits/year		Fee for service at 90% of physician fee
Guam	Yes	CN				Fee for service
Hawaii	Yes	CN & MN				Fee for service
Idaho	Yes	CN		Naturopathic services not covered		Fee for service at 85% of physician fee
Illinois	Yes	CN & MN				Fee for service at 70% of physician fee
Indiana	Yes	CN				Fee for service at 75% of physician fee
Iowa	Yes	CN & MN			Specified procedures	Fee for service
Kansas	Yes	CN & MN	$2/visit	12 office visits/year, 1 inpatient hospital visit/day, 1 nursing facility visit/month		Fee for service at 75% of physician fee
Kentucky	Yes	CN & MN				Fee for service at 75% of physician fee
Louisiana	Yes	CN & MN		12 ambulatory visits/year irrespective of setting, 1 inpatient hospital visit/day		Fee for service at 80% of physician fee with some exceptions
Maine	Yes	CN & MN			Specified procedures and services	Fee for service
Maryland	Yes	CN & MN				Fee for service
Massachusetts	Yes	CN & MN				Fee for service
Michigan	Yes	CN & MN				Fee for service
Minnesota	Yes	A & B - See state-specific FN	A - $3/visit for non-preventive service			Fee for service
Mississippi	Yes	CN	$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
Missouri	Yes	CN	$1/visit (outpatient hospital or emergency room only)			Fee for service
Montana	Yes	CN & MN	$4/visit			Fee for service, some services paid 90% of physician fee
Nebraska	Yes	CN & MN	$2/visit (specialist only) - see state-specific FN			Fee for service
Nevada	Yes	CN				Fee for service
New Hampshire	Yes	CN & MN		18 ambulatory visits/year irrespective of setting		Fee for service
New Jersey	Yes	CN & MN				Fee for service at 95% of nonspecialist physician fee
New Mexico	Yes	CN	B - $5/visit non-preventive services - see state-specific FN			Fee for service at 90% of physician fee for independent practitioners
New York	Yes	CN & MN				Fee for service
North Carolina	Yes	CN & MN	$3/visit	24 ambulatory visits/year included in limits with other specified practitioners	Specified services	Fee for service
North Dakota	Yes	CN & MN	$2/visit			Fee for service at 75% of physician fee
Northern Mariana Islands	No
Ohio	Yes	CN				Fee for service
Oklahoma	Yes	CN & MN				Fee for service
Oregon	Yes	CN & MN				Fee for service
Pennsylvania	Yes	CN & MN				Fee for service with maximums/day dependent on setting
Puerto Rico	No
Rhode Island	Yes	CN & MN - see state-specific FN				Fee for service
South Carolina	Yes	CN				Fee for service at 80% of physician fee
South Dakota	Yes	CN	$2/visit	Substance abuse treatment not covered		Fee for service at 90% of physician fee
Tennessee	Yes	A & B - See state-specific FN
Texas	Yes	CN & MN			Yes	Fee for service, some services paid 85% of physician fee
Utah	Yes	A, B & C - See state specific FN	A - $2/visit, 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
Vermont	Yes	A & B - See state-specific FN	B - $7/visit			Fee for service
U.S. Virgin Islands	Yes	CN				Fee for service
Virginia	Yes	CN & MN	$1/visit	Routine physical exams not covered		Fee for service
Washington	Yes	CN & MN				Fee for service
West Virginia	Yes	CN & MN				Fee for service
Wisconsin	Yes	CN & MN	$.50-$3, depending on service up to $30/year	1 nursing facility visit/month		Fee for service
Wyoming	Yes	CN	$2/office or home visit			Fee for service at 83% of physician fee

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