Maryland hospitals

Maryland Medicaid hospital claims at state-approved rates.

Claim

Start from a sample

Hospital

Payer

Rate-center lines

One line per rate center: units are days, visits or relative value units. For supplies and drugs (MSS, CDS) enter the hospital's cost in dollars.

    Payment

    Sample result for a 4-day medical admission at UM Shore Medical Center at Chestertown, saved from the pricing engine. Change the claim and press Price claim to price your own.

    Approved charges by rate center

    Claim lines priced at the hospital's approved rates
    Rate centerUnitsApproved rateCharge

    What each payer pays for the same claim

    Payment by payer
    PayerShare of approved chargesPays

    How it's priced

    Maryland is not a DRG state

    • Maryland sets each hospital's rates. A claim's approved charges are units times the hospital's approved unit rate for each rate center.
    • Medicaid fee-for-service pays 92.3% of approved charges (a 7.7% public-payer differential). HealthChoice MCOs pay 94.3% (5.7% base; plans may negotiate about 2% more off for prompt payment).
    • Medicare and Medicare Advantage share the 92.3% level; Medicare then takes the patient's Part A deductible and a 2% sequestration from its own share. Commercial payers pay approved charges before any negotiated discount.
    • Approved rates are rate year 2026 (effective July 1, 2025), the newest file posted publicly. Rate year 2027 rates (effective July 1, 2026) have been issued to hospitals but not yet posted, so claims on or after July 1, 2026 price about 4% low until they are.
    • Hospitals may bill above or below approved rates within the state's rate-compliance corridor, so billed charges can differ from approved ones.

    More Medicaid pricing

    Inpatient APR-DRG for New York, Texas, Colorado, Virginia and Washington, New York rate codes and Virginia fee schedules are on the Medicaid pricer.

    How Maryland pays hospitals

    Maryland is the only state where a commission sets what every payer pays a hospital. Each hospital has an approved unit rate for each rate center (room and board by day, operating room by minute, laboratory and radiology by relative value unit, supplies and drugs as a markup on cost). A claim's approved charges are the units on each line times those rates.

    Payers then pay a share of approved charges: Medicaid fee-for-service 92.3%, HealthChoice managed care organizations 94.3%, Medicare and Medicare Advantage 92.3% before patient cost share and sequestration, and commercial insurers the full approved charge before any negotiated discount. That is why the same stay can cost more than twice as much at one Maryland hospital as at another.

    Questions

    Does Maryland Medicaid use DRGs for hospital stays?

    No. Maryland's in-state acute hospitals are paid from approved charges at rates set by the Health Services Cost Review Commission. Medicaid pays 92.3% of those charges.

    Which rate year does this use?

    Rate year 2026, effective July 1, 2025, the newest file posted publicly. Rate year 2027 rates have been issued to hospitals but not yet posted.