# Is a Medicaid dental fee schedule public?

> Yes. State Medicaid dental fees are set by the state and published by it as a public record with an effective date, code by code. A commercial carrier's contracted fee schedule is the opposite: confidential under the provider agreement. That is why a Medicaid rate can be looked up and a commercial rate has to be measured or requested.

_Updated 2026-09-10. Canonical: https://www.kaylie.ai/blog/is-a-medicaid-dental-fee-schedule-public_

Yes, and this is the one part of dental fee schedules that works the way an office would
expect. A state Medicaid dental fee is set by the state programme and published by it: a
list, by CDT code, with an effective date on it, that anyone can read whether or not they
are enrolled as a provider. A commercial carrier's contracted fee schedule is the mirror
image — it is confidential under the provider agreement, it is issued to the practice that
signed it and to nobody else, and no legitimate page will show you another network's copy.
So the two questions "what does Medicaid allow for this code in my state" and "what does
this commercial plan allow" are not the same kind of question, and only one of them has a
document you can go and read.

## The two kinds of fee schedule

| | State Medicaid schedule | Commercial contracted schedule |
|---|---|---|
| Who sets the fee | The state programme | The carrier for each network |
| Published to the public | Yes as a public record | No |
| Names an effective date you can rely on | Yes | Yes — but only in the copy issued to the practice that signed it |
| Can be quoted or compared openly | Yes | No — confidential under the agreement |
| How an outsider learns the number | Read it | Measure allowed amounts on paid claims |

This is why a Medicaid article can carry a state's own fee and a commercial article cannot.
It is not a difference in how hard the two are to obtain. It is a difference in what the
document is: one is government rate-setting, the other is a negotiated price between two
private parties.

## What the practical consequence is

The consequence is where you look. For Medicaid, go to the source document — your state's
Medicaid dental programme, or the benefit manager administering that state's contract — and
read the current schedule. For a commercial plan, there is no source document available to
you, so the only honest substitutes are the allowed amounts on your own paid remittances,
your own executed fee schedule, and a measurement across practices where the individual
contract stays confidential.

That measured route has a real limit worth stating. Across the practices Kaylie serves, in
the twelve months to 10 September 2026, 19 Medicaid and Medicaid-managed-care payers
produced 78,194 adjudicated claim lines, 33,200 of them carrying a stated allowed amount on twenty
common codes — and out of 378 payer-by-code-by-state combinations, not one was backed by
five or more independent practices. 375 of them rested on exactly one. Measurement is a
weaker instrument than a published schedule, and on state-level Medicaid rates it is not a
substitute for one at all. The published schedule is better evidence than anything anyone
can measure, which is exactly why the answer to this question matters.

## Where the allowance you can see comes from

Even the allowed amount an office does see is a document, not a schedule. Of those 78,194
Medicaid claim lines, 72,101 arrived from payer portals and 6,093 from uploaded
explanation-of-benefits documents. None arrived as an X12 835 electronic remittance — the
electronic file a payer sends a practice to explain a payment. So the allowance in front of
you on these plans is whatever the portal page or the paper said, and reconciling it against
the state's published schedule is a check nobody else will do for you.

## Why the published number and your remittance can still disagree

A published state schedule is a maximum, not a promise. The allowance applied to one claim
line is normally the lesser of the schedule fee and the fee the practice charged, so an
office whose fee sits below the state's fee is allowed its own lower number and never sees
the schedule at all. Programme changes take effect on a date; a claim adjudicated across
that date is priced by whichever schedule was in force on the date of service, not the date
of payment. And a managed-care contract layered on top of a state programme can price
differently from the state's own fee-for-service list, which is why the state programme and
the benefit manager both have to be identified before a number means anything.

## What to do

- **Get your state's current Medicaid dental schedule and keep it.** It is public, it is
  free and it is the only document that settles a Medicaid pricing dispute.
- **Read the effective date, and keep the superseded copy.** Claims are priced on the date
  of service.
- **Never accept a commercial contracted schedule offered by a third party.** It is
  confidential to whoever signed it, and a copy circulating outside that agreement is not
  evidence of what your contract says.
- **For commercial plans, ask your own network representative for your executed schedule**
  and reconcile it against your paid remittances. That is your document and you are entitled
  to it.
- **Record which state programme and which benefit manager a plan sits under**, not just the
  brand on the card. One brand administers several state contracts and they do not price
  alike.

Numbers last refreshed September 2026.