For physician practices, hospitals, and facility billing teams
We work inside these systems every day. This page collects the primary sources we rely on for Medicare, Medicaid, commercial payers, and coding – the same references we use when we manage billing for physician practices and hospitals. Bookmark it and come back; these links take you to official sources rather than reproducing rates that may change. Always check the rules for the date of service, payer, and setting.
Medicare · Medicaid by state · Insurance basics · Payers · CPT & reimbursement
Medicare & CMS
Start with official Medicare program guidance, training, and claims-processing resources.
- CMS.gov – the federal agency that runs Medicare; regulations, program transmittals, and policy updates
- Medicare Physician Fee Schedule – how Medicare prices professional services
- Physician Fee Schedule lookup – look up Medicare professional-service pricing and payment indicators by code and locality
- Medicare Learning Network (MLN) – free official CMS training and MLN Matters articles on billing policy
- National Correct Coding Initiative (NCCI) – official Medicare coding edits and guidance
- CMS Internet-Only Manuals – the rulebooks for Medicare claims processing
- Medicare.gov – the patient-facing Medicare site
Medicaid: State by State
Medicaid is run by each state, so billing rules, portals, and fee schedules differ. Our home markets first:
New York
- New York State Medicaid – program home, NY State Department of Health
- eMedNY – the NY Medicaid provider portal: claims, eligibility, remittances
New Jersey
- NJ Division of Medical Assistance and Health Services – NJ Medicaid program home
- NJMMIS – the NJ Medicaid provider portal: claims, eligibility, remittances
Nationwide Medicaid directory
All 50 states and DC are covered here, with New York and New Jersey above. Open the state agency or program site for current guidance for your provider type.
- Alabama
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- District of Columbia
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Mexico
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming
For an alternative nationwide agency directory, use Medicaid.gov state agency contacts. Program data and scorecards: Medicaid.gov State Overviews.
Health Insurance Basics
Plain-language explainers, useful when a patient asks what a deductible or EOB actually is.
- HealthCare.gov Glossary – plain-language definitions of common insurance terms
- CMS Coverage to Care – official consumer education on using health coverage
Major Payers & Marketplaces
Provider portals for eligibility checks, prior authorizations, claims status, and fee schedules.
- UnitedHealthcare – UHCprovider.com – provider portal and resources
- Cigna Healthcare for Providers – provider portal and resources
- Aetna for Health Care Professionals – provider portal (Availity) and resources
State health insurance marketplaces, where many patients with marketplace coverage bought their plans:
- NY State of Health – New York’s official health plan marketplace
- Get Covered NJ – New Jersey’s official health insurance marketplace
CPT Codes & Reimbursement
A professional fee and a hospital facility payment are not interchangeable. Use the resource that matches the claim type and setting. A fee schedule is a reference, not a guarantee of coverage or payment.
For physician practices
- CMS Physician Fee Schedule lookup – Medicare professional-service pricing, where applicable
- AMA CPT – about the CPT code set, from the organization that maintains it
- Download: CPT Reimbursement Basics (PDF) – our one-page reference on how a code becomes a payment and how to look up its Medicare rate
For hospitals & facilities
- Hospital Outpatient PPS (OPPS) – how Medicare pays hospital outpatient departments
- Acute Inpatient PPS (IPPS) – how Medicare pays inpatient stays under DRGs
Questions about a specific claim, rate, or denial? Contact us – this is the work we do for practices and facilities every day.
Educational resources only. External sites have their own terms and may require registration. Links reviewed November 2026. CPT is a registered trademark of the American Medical Association.