96116 Medicaid reimbursement rates by state
Mental health assessment (non-physician). 43 state Medicaid programs publish a fee-for-service rate for 96116 at the physician psychologist level. Rates run from $40.23 in New Jersey to $825.87 in California, with a median of $78.39.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 43
- Median rate
- $78.39units vary by state
- Highest
- $825.87California
- Medicare (non-facility)
- $89.56–$126.312026 physician fee schedule
96116 rate in every state
One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| CaliforniaPhysician or licensed psychologist (incl. BCBA-D) · California Medi-Cal Specialty Mental Health Services (DHCS fee schedule for county Mental Health Plans) | $825.87⚠ over 3× mediansince 2026-07-01 | — | — | Paid by the state, outside plans | — | Medi-Cal Behavioral Health Fee Schedules |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $322.24⚠ over 3× mediansince 2026-01-01 | — | — | Plans negotiate; applies out of network | — | OHA Administrative Examinations and Repo |
| NebraskaPhysician or licensed psychologist (incl. BCBA-D) · Nebraska Medicaid (fee-for-service) | $245.49⚠ over 3× mediansince 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid Mental Health and Subs |
| UtahPhysician or licensed psychologist (incl. BCBA-D) · Utah Medicaid (fee-for-service, Traditional plan) | $195.53since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| AlaskaPhysician or licensed psychologist (incl. BCBA-D) · Alaska Medicaid behavioral health services (State Plan, Division of Behavioral Health) | $175.89since 2026-07-01 | hour | $175.89 | Not classified | — | Fee Schedule - Independent Psychologists |
| MontanaPhysician or licensed psychologist (incl. BCBA-D) · Montana Medicaid and HMK Plus (fee-for-service) | $148.28since 2026-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $147.22since 2021-01-01 | — | — | Plans negotiate; applies out of network | — | 2026 Fee Schedule - Covered Procedures R |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $132.53since 2025-01-01 | — | — | Plans must pay at least this | — | Fee Schedule for Behavioral Health Provi |
| MassachusettsPhysician or licensed psychologist (incl. BCBA-D) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $132.51since 2025-09-01 | — | — | Plans must pay at least this | — | Rates for Mental Health Services Provide |
| MainePhysician or licensed psychologist (incl. BCBA-D) · MaineCare (fee-for-service) | $118.59since 2026-01-01 | 1-hour | — | Not classified | — | MaineCare Section 65 Behavioral Health r |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $108.16since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $101.35since 2024-07-01 | — | — | Not classified | — | CMAP fee schedule: Clinic and Outpatient |
| AlabamaPhysician or licensed psychologist (incl. BCBA-D) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $96.51since 2025-12-01 | — | — | Not classified | — | Behavior Health Services Fee Schedule |
| MissouriPhysician or licensed psychologist (incl. BCBA-D) · Missouri MO HealthNet (fee-for-service) | $94.83since 2022-07-01 | — | — | Plans must pay at least this | — | MO HealthNet fee schedule: Behavioral He |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $90.53since 2017-01-01 | — | — | Plans negotiate; applies out of network | — | Physician Maximum Allowed Fee Schedule - |
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $89.61since 2026-07-01 | — | — | Not classified | — | South Dakota Medicaid Physician fee sche |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $88.13since 2023-07-01 | — | — | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $82.23since 2017-01-01 | — | — | Plans must pay at least this | — | Provider Type 26 Psychologist Reimbursem |
| New YorkPhysician or licensed psychologist (incl. BCBA-D) · New York Medicaid (fee-for-service) | $82.07since 2023-10-01 | unit | — | Plans negotiate; applies out of network | — | eMedNY Physician Fee Schedule Sect 2 (Me |
| WyomingAny qualified provider (rate does not vary by provider) · Wyoming Medicaid (fee-for-service, Department of Health) | $79.24since 2026-07-01 | — | — | Not classified | — | Wyoming Medicaid Downloadable Fee Schedu |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $78.91since 2026-01-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - CPT Code |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $78.39since 2026-07-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| MinnesotaPhysician or licensed psychologist (incl. BCBA-D) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $77.62since 2026-05-21 | hour | $77.62 | Plans must pay at least this | — | MH Procedure CPT or HCPC Codes and Rates |
| HawaiiAny qualified provider (rate does not vary by provider) · Hawaii Medicaid (Med-QUEST) fee-for-service | $77.42since 2026-06-01 | — | — | Plans must pay at least this | — | Medicaid Fee-For-Service (FFS) Fee Sched |
| OklahomaPhysician or licensed psychologist (incl. BCBA-D) · Oklahoma SoonerCare (fee-for-service, OHCA) | $76.24since 2022-07-01 | — | — | Plans must pay at least this | — | ODMHSAS PICIS 'SoonerCare - Psychologist |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $75.77since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| LouisianaPhysician or licensed psychologist (incl. BCBA-D) · Louisiana Medicaid (fee-for-service) | $75.29since 2025-07-01 | — | — | Plans must pay at least this | — | Specialized Behavioral Health Services f |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $75.06since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Child Health Plan Plus Behavioral Health |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $74.09since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $73.75since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file cptmedical4.csv |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $72.86since 2025-10-01 | — | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Independent Di |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $72.68since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| OhioAgency provider · Ohio Medicaid (fee-for-service) | $72.27since 2024-01-01 | hour | $72.27 | Plans expected to pay at least this | — | OAC 5160-27-03 Appendix A, Community Beh |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $70.00since 2012-01-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $68.72since 2021-09-30 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $68.22since 2020-01-01 | hour | — | Plans negotiate; applies out of network | — | DMS CMHC Mental Health Substance Abuse f |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $66.24since 2026-03-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $65.64since 2026-04-01 | — | — | Plans negotiate; applies out of network | — | BMS RBRVS 2026 Effective 4/1/26 - 3/31/2 |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $61.51since 2017-01-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $60.07since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Child and Adolescent Health Center |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $56.18since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Mental health and psychology service |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $56.11since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | Practitioner Fee Schedule (2026-01-01) |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $40.23since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.
Frequently asked questions
What does Medicaid pay for 96116?
It depends on the state. Of the 43 states with a published fee-for-service rate, the median is $78.39. California pays the most ($825.87) and New Jersey the least ($40.23).
Which state pays the highest Medicaid rate for 96116?
California, at $825.87, effective 2026-07-01.
Do managed-care plans pay the same rate for 96116?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The table shows the rule for each state, cited to the contract or statute.
Related Behavioral health codes
90791Mental health assessment (non-physician) · 48 states90832Outpatient psychotherapy and diagnostic evaluation · 48 states90834Outpatient psychotherapy and diagnostic evaluation · 48 states90837Outpatient psychotherapy and diagnostic evaluation · 48 states90847Outpatient psychotherapy and diagnostic evaluation · 48 states90853Outpatient psychotherapy and diagnostic evaluation · 48 states96130Mental health assessment (non-physician) · 48 states96131Mental health assessment (non-physician) · 48 states96136Mental health assessment (non-physician) · 48 states96137Mental health assessment (non-physician) · 48 states99202New-patient office visit, level 1 of 4 · 48 states99203New-patient office visit, level 2 of 4 · 48 states
Track 96116 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.